Health Forms & Requirements

Health Forms and Requirements

Please review Hamel Health Center’s student health forms. 

Health Forms for Spring 2023 Students

Due: Thursday, Dec. 15, 2022
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. Immunization Form (download Immunization Record Form, have your healthcare provider fill it in and upload it to the 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. Immunization Form (download Immunization Record Form, have your healthcare provider fill it in and upload it to the Patient Portal)
Form Assistance

If you need assistance filling in any of our forms, please contact us at 978-837-5441
or hamelhealthcenter@merrimack.edu.