Medical Information Form

BSM Medical Information Form

Instructions:

We are asking you to fill out this medical information sheet for precautionary measures. In the event of a medical emergency, this form will be a source of reliable information, so it is important to fill it out accurately and completely. The information will be accessible by our staff in Budapest. All fields are required to participate in the program.

Please note that counseling is available on campus in Budapest. Refer to our student handbook and staff in Budapest for more information.
  • It is required to have an appropriate Health Insurance Policy during your stay in Hungary.
  • If you wear glasses or contacts, please list your prescription information.
  • Please list all known allergies. Use the Ctrl key on a PC or Command key on a Mac for multiple selections.
  • If you answered yes to any of the allergies, please be more specific so we can best prepare.
  • Do you have any of the following pre-conditions? Use the Ctrl key on a PC or Command key on a Mac for multiple selections.
  • If you have answered yes to any of the above medical pre-conditions, please provide specific details so we can plan accordingly.
  • Are you on any medication? If so, please list all medications, the dosage, and the reason you are taking it. Try to bring enough for your entire stay. Important: it is illegal to mail prescription meds from the U.S. to Hungary.
  • BSM is committed to providing all participants with equal access and opportunity to our academic environment. Are there any circumstances relating to academic, housing, transportation or medical needs which require special accommodations? Provide details below.