Forms

Incoming Students

Student's Medical History, Health Evaluation, Immunization Record and Tuberculosis Screening forms which must be completed and returned no later than July 1st for fall semester or December 15th for spring semester.

• Pre-Entrance Health Requirements (doc)
• Medical History/Physical Examination (PDF)
• Immunizations
  • Immunization Record (PDF)
  • Tuberculosis Screening (PDF)
• Meningococcal Information Waiver (PDF)
• Permission for treatment for students (PDF)
  Under 18 years of age
• Competitive Athletics Form (PDF)

Request for Health Records

These must be completed and signed prior to requesting a copy of your medical record for yourself or another provider or requesting health information from another provider to be sent to Mount Holyoke College.

• Release form from MHC Health to Other Provider (doc)
• Release form from Other Provider to MHC Health Center (doc)

Travel

Form must be submitted online 48 hours prior to scheduled visit for Travel advice and travel immunizations.