Health Requirements & Forms

Health Services Patient Portal

Please submit all documentation through the Student Health Portal. For electronic medical record security, we are unable to accept forms by fax or email.

Per Massachusetts regulations, 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 their health forms on file.

Important COVID-19 Information

All enrolled students are required to have completed a primary COVID-19 vaccination series. Additionally, students are required to obtain a booster shot within 4 days of eligibility.

To find a vaccination site near you visit the Massachusetts Vax Finder website.

Once students have had their booster, they should upload their booster information to the student health portal.

UMass Lowell will evaluate requests for medical and religious exemption consistent with state and federal laws. Information about applying for a vaccination exemption can be obtained by calling 978-934-6800 or by emailing wellness_center@uml.edu. Exemption requests for the primary COVID-19 vaccines are due 30 days prior to the start of the semester. Exemptions are active for the academic year. Students with existing exemptions will need to re-submit their requests for each academic year.

Online Health Record

All newly enrolled 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) - Upload medical documentation signed by medical provider.
  • Two doses MMR (Measles, Mumps, Rubella) vaccine or a positive blood titer test .(laboratory documentation required)
  • Two doses of Varicella vaccine for Chicken Pox or documented history of disease, or positive blood titer (laboratory documentation required)
  • Three doses Hepatitis B (Engerix B) or two doses Hepatitis B (Heplisav) or positive blood titer (laboratory documentation required)
  • One dose of Tdap vaccine within 10 years. If received more 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 a Meningococcal ACWY vaccine on or after their 16th birthday; or, sign the Department of Public Health's Meningococcal Disease and Vaccination Waiver Form.
  • COVID-19 vaccine – fully vaccinated with a U.S. Food and Drug Administration or World Health Organization authorized vaccine, including booster shots.
• 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.

Due Dates

All health records are required by Aug. 1 for fall enrollment and Jan. 1 for spring enrollment.

Failure to submit mandatory health records will result in a hold on your registration and possible removal from enrollment.

Complete and upload forms via the secure Patient Portal.

Questions?

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