Health Services Requirements & Forms
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.
Please download these forms, print out, complete and submit them to us:
Students should complete both pages of the Health Examination Report as well as the first page of the Tuberculosis Risk Assessment. The remaining forms 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.
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.
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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 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.
All matriculating students who have met the Health Services requirements are eligible to use services. Please bring your student ID and Medical Insurance card to your appointment.
Please call us at 978-934-4991 or contact us with any questions.