This form is used to transfer medical records to or from another clinic or individual.
Please complete this form prior to coming to your first appointment at Student Health Services.
This form is required if you graduated high school from outside the state of Minnesota or before 1997. You should have received information and a link to this form in your admitted student letter. You may submit the form electronically or send to Student Health Services, 21 Carkoski Commons, Mankato, MN 56001; fax (507) 389-5787; email healthservices@mnsu.edu. This information is required before you can register for the following semester at Minnesota State Mankato.
Minnesota State
University, Mankato
Mankato, MN 56001
1-800-722-0544
© 2005-2013 Minnesota State University, Mankato. Minnesota State University, Mankato is a member of
Minnesota State Colleges & Universities system and an affirmative action/equal opportunity university.
