Student Life and Student Services
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Health Services

Forms to be Completed Prior to Attending Classes

Student Immunization Form
New York State law requires that all students born on or after January 1, 1957, and who enroll in six or more credits for any given term must provide proof of immunity to measles, mumps and rubella. Read more about immunizations.

Request For Religious Waiver From Immunization
Required for any student seeking to submit a religious waiver from NYS immunization requirements.

Meningitis Self-Reporting Form
Students also are required by New York State law to have a meningitis response form on file. This is simply a requirement for a signed form; an immunization is not required. Read more about meningitis.

Health Science Physical Form
Required for students in the following programs: Early Childhood and Health Science Students, including: Dental Hygiene, Diagnostic Medical Sonography, Echocardiography, Invasive Cardiovascular Technology, Mortuary Science, Nursing, Paramedic, Respiratory Care, Radiologic Technology and Surgical Technology.

Athletic Preparticipation Physical Evaluation History Form
Required for all student athletes.


Miscellaneous Form

Authorization for Disclosure
Permits the college to release immunization, treatment, laboratory and physical exam records as necessary.


Forms to be Completed When Being Seen/Treated in Health Services

Health History Form
Required for any student or employee who visits Health Services seeking care.

Student-Athlete Physical Exam in Health Services
To be completed by student-athletes at the time of the scheduled physical exam at Health Services.

Acknowledgment of Notice of Privacy Practices
Required by anyone being seen/treated in Health Services. View the Notice of Privacy Practices.

Consent for Services
Required by anyone being seen/treated in Health Services.