Student Health Services
275 Mount Carmel Ave
Hamden CT, 06518
(203)582-8742
Operating Hours: 24 hours a day, 7 days a week.

STEP 1 :
            Students starting in   January 2016    ------------  Due by January 9, 2016
            Students starting in       May, 2016     ------------  Due by May 15, 2016
            Students starting in    August 2016    ------------  Due by May 31, 2016
Transfer students starting in August 2016     ------------  Due by June 15, 2016
Graduate students starting in August, 2016   ------------  Due by June 29, 201
6


*1. On-Line Form: After Logging in, Click on the Personal Form link on the left of the page and follow instructions


THE ON-LINE PERSONAL FORM IS REQUIRED BEFORE ATTENDING ORIENTATION ON CAMPUS.



STEPS 2 and 3 :
            Students starting in   January 2016   ------------  Due by January 9, 2016
            Students starting in       May, 2016    ------------- Due by May 15, 2016
            Students starting in    August 2016   ------------- Due by June 30, 2016
Transfer students starting in August 2016   ------------- Due by June 30, 2016
Graduate students starting in August, 2016 ------------  Due by June 30, 2016

*2. All Full Time Students: Choose and PRINT the Student Health Services Physical Examination Form. A physical exam, within 2 year prior to the start of class must include: 
     • 2 MMR’s – per guidelines indicated on the health form
     • TB Screening – per guidelines indicated on health form
     • Meningitis conjugate vaccination – required of anyone residing in university owned housing and within 5 years of enrollment
    • Varicella documentation of either diagnosis of chicken pox disease documented by your healthcare provider, documentation of 2 doses of the Varicella vaccine or proof of immunity by titer
    • Signature of Physician, Physician Assistant or Advanced Practice Registered Nurse on Page 1 of the Immunization Form, Page 3 if applicable for Tuberculosis Form and Page 4 of the Physical Examination Form
    • Consent Form signed by student and parent if student under age 18.
*3. On-Line Immunization: Click on the Immunization link on the left of the page , choose New and complete dates for all immunizations for which you have documentation .


AFTER COMPLETION OF THESE THREE REQUIREMENTS PLEASE MAIL PHYSICAL FORM, TUBERCULOSIS SCREENING, TUBERCULOSIS TESTING FORM AND IMMUNIZATION DOCUMENTATION TO STUDENT HEALTH SERVICES by due date for verification


**PART TIME GRADUATE STUDENTS ONLY: Choose and print the Part Time Graduate Health Form. Part Time Graduate Students: No On-line Personal Health Form is required.


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