Pre-Entrance Health Requirements

There are a number of forms that must be completed and returned to the Health Center at Mount Holyoke College. For students entering the College in the fall, forms are due by July 1, 2009; for students entering in spring 2010, forms are due December 15, 2009. These forms must be downloaded, printed and completed by you and your health care provider. These cannot be completed online.  Each file is a 3 page, one page of instructions and a two sided form. These may be printed as either single or double sided forms.

• Consent to Treat (If under age 18) (PDF)
• Medical History/Physical Exam (All students) (PDF)
• Immunization Record (All students) (PDF)
• Tuberculosis Screening Form (All students) (PDF)
• Meningitis Waiver (See Instructions) (PDF)
• Pre-participation Evaluation for Sports (See Instructions) (PDF)

If you are unable to download and print the forms we will mail them to you. Please email us at health services and include your name and mailing address.

The Pre-entrance Health Requirements apply to all incoming and transfer students.

ALL FORMS ARE TO BE SUBMITTED BEFORE YOUR ARRIVAL ON CAMPUS

Incomplete health forms or lack of immunizations and TB screening may delay class registration. Please be certain that your name and date of birth is printed clearly on each page. One of the most common omissions is the failure to properly complete the TB Screening Form. Please be sure your health care provider has reviewed and signed all forms.You will be receiving information about the Student Medical Insurance Plan available at Mount Holyoke College with the tuition bill in July.You may access additional forms, information about health services and information regarding health insurance and billing by using the navigational selections on this website.

Health Services is closed from May 22^nd through September 3^rd. During this time, clerical staff is receiving and reviewing health forms. The staff also monitors and responds to voice mail and email messages. You may leave a voice mail message with your question or concern at 413-538-2089 or email us at health services. It is not necessary to notify us if your forms are arriving after July 1, 2009.  Be aware, however, that missing information or delay in receiving your forms will hamper our ability to verify that you have met all the pre-entrance health requirements.

Thank you for your cooperation and welcome to Mount Holyoke College!