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Get the free U of W Insurance Claim Formand Consent: Influenza ...

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Mercy Consents for Influenza Vaccination n Billed to Insurance Employer Pay1. I have been given the opportunity to read or had explained to me the information in the Vaccine InformationStatement(s),
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Gather all necessary personal information such as name, address, date of birth, and student ID number.
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Fill out the insurance application form completely and accurately.
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Who needs u of w insurance?

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Students enrolled at the University of Washington who are looking for health insurance coverage.
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Students who do not already have health insurance or are looking for supplemental coverage.

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