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Wake Forest University School of Medicine
STUDENT HEALTH INSURANCE PLAN

Waiver Form
2024-2025 Academic Year

Before waiving the student health insurance plan, please review your current plan to ensure it provides comparable benefits to the student insurance plan for providers located in North Carolina. 

The policy of the School of Medicine is that any charges incurred that are not covered by insurance will be the student's responsibility. Regular clinical activities after matriculation by the Employee Health Center will not create any accounts for the individual student.

TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:

Asterisk (*) denotes required field

 (MM/DD/YYYY)