Health Services Patient Portal
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 download 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.
- Meningococcal Disease and Vaccination Waiver Form (pdf) - View Meningococcal Disease Information Sheet. All new college students who live in campus housing must receive one of the Meningococcal vaccines or sign the Department of Public Health's Meningococcal Disease and Vaccination Waiver Form.
- Immunizations (pdf) - Enter dates for required immunizations online and upload supporting medical documentation signed by Medical Provider.
- 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 fax or mail 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.
- Fax completed forms to 978-934-3080.
- Mail 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.
Questions?
Please call us at 978-934-6800 or contact us with any questions.