As a condition of admission to the University and subsequently, treatment at Health Services, all students are required to have the following forms on file.
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Please 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.
Please note: You will be allowed to register for your first semester classes, but you will not be allowed to register for subsequent semesters unless your immunization record is complete and up to date within 30 days of the start of your first semester.
As of August 2007, the Massachusetts Department of Public Health has mandated that all new college students, who live in campus housing receive one of the Meningococcal vaccines or sign the Department of Public Health's Meningococcal Disease and Vaccination waiver form (pdf). This form is also available for pick up at Health Services.
Effective September 1, 2011: The Massachusetts Department of Public Health has added new immunization requirements for all newly enrolled students as well as all Health Professions students. These immunizations include Tdap and Varicella. Please see the immunization forms for further information.
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. Even if you have agreed to have your academic records transferred 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.