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.
- Meningococcal Disease and Vaccination Waiver Form (pdf) - View Meningococcal Disease Information Sheet. All newly enrolled full-time college 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.
- 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 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.
- Complete and upload forms via the secure Patient Portal
- Mail or bring completed forms to:
UMass Lowell Health Services
220 Pawtucket Street, Suite 300
Lowell, MA 01854-5144