Lindenbaum - 2024 CHAI 'Wellcome' Student Health Policy Sign Up
To signup for this insurance policy, please proceed as follows:
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Download this PDF form
The form does not have to be printed, and can be filled out on your computer. - When you're done, don't forget to save it, and return to this page
- Proceed below to fill out the personal details and upload the form you have just filled out.
Please note when filling out the form:
- If you are taking medication, please state the reason (question 8)
- If you have been hospitalized/had surgery-please give dates and details (questions 9, 10)
- Alcohol- if yes, state social drinking (unless other) question 12
- Chronic conditions-pls provide current doctor’s letter (questions 15, 16, 17)
- Please add an extra page if you need to add information.
- Date of birth - you MUST give the Israeli date format: DD/MM/YYYY.
- You MUST give your weight, height and waist circumference in kilograms and centimeters.