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Health Requirements & Forms

Health Services Patient Portal

Please note: for electronic medical record security, we are unable to accept forms by fax or email.

Per Massachusetts law, as a condition of enrollment at the university and subsequently, treatment at Health Services, all full-time students, and part-time Health majors are required to have the following health forms on file.

You will need Adobe Acrobat Reader to view any pdf files. It can be downloaded for free from the Adobe website.

Online health record

Students should complete the health forms online and upload supporting medical documentation through the Health Services Patient Portal link above.

  • Health History (pdf) - Students must complete both parts of the Health History Form.
  • Tuberculosis Risk Assessment Questionnaire (pdf) - View list of TB-Endemic countries and answer questions.
  • Immunizations (pdf) - Enter dates for required immunizations online and upload supporting medical documentation signed by Medical Provider.
    • Two doses MMR (Measles, Mumps, Rubella) vaccine or a positive blood titer test
    • Two doses of Varicella vaccine for Chicken Pox or documented history of disease, or positive blood titer
    • Three doses Hepatitis B or positive blood titer
    • One dose of Tdap vaccine within 10 years. If older than 10 years, you must also have a documented Td given within 10 years. Note: Massachusetts regulations require all full-time students have a current tetanus immunization throughout their enrollment.
    • Meningococcal vaccine - All newly enrolled full-time students 21 years of age or younger must receive one of the Meningococcal vaccines; or, sign the Department of Public Health's Meningococcal Disease and Vaccination Waiver Form.
  • Physical Examination Form (pdf) - Download the Physical Examination Form and bring to your Medical Provider for completion; upload to the Patient Portal. We will also accept the Medical Provider's form. Physical examination should be performed within the past 12 months.

If you are unable to complete and upload the required forms online, you can download the forms above and mail or bring them to Health Services.

Due Dates

All health records are required by August 1 for fall enrollment and January 1 for spring enrollment.

Failure to submit mandatory health records will result in a hold on your registration.

  1. Complete and upload forms via the secure Patient Portal
  2. Mail or bring completed forms to:
    UMass Lowell Health Services
    220 Pawtucket Street, Suite 300
    Lowell, MA 01854-5144

Transfer Students

Transfer students must request a copy of their immunization records on file at a previous school. If you have agreed to have your academic records transferred from a previous school, you MUST make a separate request for health records due to the sensitive nature of that information. You may use the following form to facilitate the transfer of these records to UMass Lowell Student Health Services.

You will need Adobe Acrobat Reader to view any pdf files. It can be downloaded for free from the Adobe website.

Questions?

Please call us at 978-934-6800 or contact us with any questions.

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