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:
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.
Transfer students may wish to request a copy of their immunization records on file at a previous school. You may use the following form to facilitate the transfer of these records to UMass Lowell Student Health Services.
Authorization for Release of immunization records (pdf)
You will need Adobe Reader to view these pdf files. Adobe Reader can be downloaded, free of charge, from the Adobe website.
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.