This medical information sheet is for precautionary measures and is required by ¶4.2 of the BSM contract. In the event of a medical emergency, this form will be a source of reliable information, so it is important to complete it listing all medical conditions. The medical information will be accessible only to our staff in Budapest and the North American Office. All fields are required to participate in the program.
I affirm the information provided in this form is complete and accurate. I assume full responsibility for any undisclosed physical or psychological conditions that might impair my ability to complete the program. Check the box below to confirm.
It is required to have an appropriate Health Insurance Policy during your stay in Hungary.
Enter the name, phone number and email address.
If not enter "NONE" or enter the name, phone number and email address.
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 listed or selected any of the above medical pre-conditions, please provide specific details so we can plan accordingly.
Please note that BSM has a psychologist on-site with limited hours. Counseling is available in Budapest but is very different than in the U.S. and with limited access. Refer to our staff in Budapest for more information. List any mental health conditions in the text box below. If you answered "yes" or listed any conditions, please consult your physician or psychologist (health care provider) as you plan to travel abroad.
Will you be taking any prescription medication while in Budapest? If so, please list all medications, the dosage, and the reason you are taking it. You will need to bring enough for your entire stay and a doctor's note certifying that you need the medication.
Important: it is illegal to mail prescription meds from the U.S. to Hungary, bring an ample supply with you for the semester.
*If you are taking daily medications, email our Director of Student Services, Ms. Anna Foti at firstname.lastname@example.org, with the list to determine if they are legal and/or available in Hungary. Some prescription medicines, like Adderall, have components that are illegal to bring to and possess in Hungary. It is important to contact your physician prior to departure to determine if an alternative medical prescription is available if your current medication will not be available or legal. Illegal medications will be confiscated by customs.
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.
I have completed this form honestly, accurately and fully.