Incoming Health Forms

Welcome Class of 2021 and all new students

We would like to congratulate you and welcome you to the Mount Holyoke Community. As you are preparing to begin your studies, several health related topics need your attention and action.  We are very pleased to announce the implementation of My Health Connection, the portal to your electronic medical record. Click the link for the portal below to complete the forms that are required. Your user name and password for the portal is the same to access email and MyMtHolyoke.

Pre-entrance Health Requirements

All incoming students must complete these requirements prior to arrival on campus. Both online and printed forms have been updated and must be  accessed through a newly created My Health Connection portal.

Online Forms

Immunization Records: After entering the dates online, you will need to submit a verified copy of your immunization record which includes: 2 doses of MMR vaccine, 2 doses of varicella vaccine, 3 doses of Hepatitis B vaccine, one dose of meningitis vaccine within the past 5 years, one dose of Tdap vaccine. Please click here to view instructions. Download our form or submit a copy from your physician's office for verification.

Medical history form

Tuberculosis Screening Form

Downloadable Forms

These forms require printing, completion and signature of medical provider:

Physical Exam completed after 8/15/16

TB Testing Form for those who answer yes to question on the screening form and can have testing done within the US or Canada. Students from outside the US will have testing done as part of the Schedule Orientation on September 1, 2017.

Sports Clearance Packet: Additional forms are required for students who are varsity athletes or plan to participate in club sports.  This packet includes additional medical history, medical clearance specific for sports participation, physical exam completed after February 15, 2017 and sickle cell testing or waiver form.

Forms can be Email: health-services@mtholyoke.edu or to Fax: (413) 538-2352

Deadline for Forms

Complete all health forms by July 15 for Fall admits and December 1 for Spring admits. Students will not be allowed to pick up keys or check into housing if the Incoming Health Forms have not been received by College Health Services.

Forms can be Email: health-services@mtholyoke.edu or to Fax: (413) 538-2352