Hamel Health Center

Health Forms & Requirements

Health Forms and Requirements

Flu Immunization Form

Due: Dec. 10, 2020
For: Current and New Undergraduate and Graduate Students


How to Submit Your Flu Immunization Form: 
  1. Visit the Patient Portal, log in and upload your form or
  2. Email us your form at hamelhealthcenter@merrimack.edu or
  3. Fax us your form at 978-837-5209

Health Forms for New Students

Due: Dec. 10, 2020
For: New Undergraduate and Graduate Students Only 

 

Undergraduate Student Requirements
  1. TB Questionnaire (available on Patient Portal)
  2. Health History Form (available on Patient Portal)
  3. Consent for Treatment (available on Patient Portal)
  4. Immunizations Form (download immunizations form and upload to Patient Portal)
  5. Most Recent Physical (submit a copy via Patient Portal)
Graduate Student Requirements
  1. TB Questionnaire (available on Patient Portal)
  2. Health History Form (available on Patient Portal)
  3. Consent for Treatment (available on Patient Portal)
  4. Immunizations Form (download immunizations form and upload to Patient Portal)