Student Health Services

Claim Form

To file a claim:

1. Obtain a claim form from the Student Health Service or from Collegiate Risk Management or download the claim form below.
2. Complete the form.
3. Submit all claims, including itemized bills, to:
   Student Health Services
   051 Student Union
   Wright State University
   3640 Colonel Glenn Hwy.
   Dayton, OH 45435-0001
4. Written proof of loss must be furnished within 90 days after the date of such loss.

Claim Form (1 page)

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