Per Massachusetts law, as a condition of enrollment at the university and subsequently, treatment at Health Services, all students are required to have the following forms on file.
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download ALL of these forms, print them out, complete and submit them to health services:
Students must complete both pages of the Health Examination Report as well as the first page of the Tuberculosis Risk Assessment. The Immunization Form and the Physical Examination Form must be completed by a health care provider. Students may submit a physical examination performed within the past 12 months.
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.
- Fax completed forms to 978-934-3080.
- Mail completed forms to:
UMass Lowell Health Services
220 Pawtucket Street, Suite 300
Lowell, MA 01854-5144
Consent for Medical Care
A signature of a parent/guardian is required on the Consent for Treatment form (pdf) of a student who is under 18 years of age, and is valid until age 18.
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.
Please call us at 978-934-6800 or contact us with any questions.