Health Forms for Students
**Health forms are due July 15 for the fall semester and January 15 for the spring semester. If the forms are not submitted, class registration and first-day move-in may be delayed.**
Required Forms
To complete the new student health forms, you will need to register for an account through the 91猫先生 / UMass patient portal.
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When registering, use your 91猫先生 email address (e.g. xxx25@hampshire.edu).
After logging into the , find the 91猫先生 Health and Counseling Clinic (option #6). Go to the 鈥淔orms鈥 tab to access and complete these forms:
Required Forms:
- New Student Health Form (completed by new student)
- Immunizations Form (download from portal or link below, completed by health care provider, upload to portal)
- Tuberculosis Screening Form (completed by new student)
- Acknowledgment of Privacy Practices (completed by new student if over 18)
- Financial Responsibility Form (completed by new student if over 18)
Optional Form (for athletes only):
- Annual Physical听(download from portal or link below, sign release of information, have provider complete, then upload both forms via the patient portal.)
Please keep in mind: If you do not have the chance to receive all required immunizations before the due date (July 15 for the fall semester and January 15 for the spring semester), please upload what you have, then contact the Health and Counseling office to make a plan.
Thank you for your assistance in meeting these College requirements. If you have any questions, please contact Health and Counseling Services at 413.559.5458.听
Massachusetts state law requires that all college students are covered by health insurance. 91猫先生 works with 听to offer a student insurance plan that is tailored to the needs of our students. The Student Health Insurance Plan will be billed along with your tuition. If you have comparable medical coverage through another insurance plan, you can waive this fee.
Downloadable Health Forms
Please download the appropriate forms and have them completed by your medical provider.
Once completed please log into the 听to upload the forms.听
You may also听send health forms via USPS to 893 West Street, Amherst MA 01002; or fax forms to 413.559.5583
Blank forms are also available through the patient portal.
If you have any questions, please call our office at 413.559.5458 for assistance.
New Student Forms听听
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Vaccine Waiver Forms:
Tuberculosis Testing & History
- ONLY if directed by Health and Counseling Services staff, please听print and have your healthcare provider complete this听form.听
- After the document is completed and signed by your provider, login to the patient portal and upload the document.
Athlete Forms听
All 91猫先生 athletes must have a yearly physical exam which must include provider recommendations / clearance for activities to participate in athletics at 91猫先生.听听听
- Please download and print the below form and bring it to your healthcare provider to complete.听
- Please upload the documentation via the ,听send via USPS to (893 West Street, Amherst MA 01002) or fax to 413.559.5583.
- If you have not had an annual exam at home in the past 12 months, you may be eligible to receive one at 91猫先生 Health and Counseling Services.