Health Center

Forms

 

   a photo of forms

**Please note, if you are a returning student and you have already submitted your health records the previous year/semester, then you do not need to resubmit any information. The information you submit as a Freshman/Transfer student will cover you through graduation.** 

The Health Report is not mandatory but it is strongly recommended for students who are planning to use the services offered at the Student Health Service. If you are unable to submit a completed copy of the Health Report, submit a copy of your immunization records and a copy of your most recent physical done at your doctor's. If you would like more information as to what immunization information is required from you, please click the following link Immunization Requirements. If you are a Varsity Athlete and you want to know what must be submitted for Athletic Clearance, please click the following link Athletic Clearance

Submit all documents via the Immunization Document Portal on my.newpaltz.edu

Immunization Records (Required prior to the start of classes)

Health Report (Recommended)

Questions?? Call Student Health Service 845-257-3400

**Immunizations/Health Report should be submitted 1 month prior to classes to allow for processing** 

**NEW STUDENT/FRESHMAN HEALTH PAPERWORK** (we will accept physicals up to 2 years old for non-athletes)

**Please download these forms to your desktop and complete them in Adobe. If you complete the forms in a web browser, they will not save properly. If completing the forms in Adobe is not possible, please print out the forms, complete them by hand and scan them back to us. There are many free scanner apps for smart phones you can utilize. You can also try completing the forms on your smart phone or tablet and emailing them back to us.

Health Report- If the doctor does not wish to complete pages 5 and 6, you may attach copies of your immunization records and your most recent physical (we accept physicals up to 2 years old). This Health Report includes all the Health Information we will need from you.

 

ISOLATION AFFIRMATION FORMS

Affirmation of Isolation

Isolation Quarantine FAQ

 

Pre-Appointment Forms:

The following forms are only to be completed if asked to do so by a Triage Nurse for an appointment at SHS.

**Please download these forms to your desktop and complete them in Adobe. If you complete the forms in a web browser, they will not save properly. If completing the forms in Adobe is not possible, please print out the forms, complete them by hand and scan them back to us. There are many free scanner apps for smart phones you can utilize. You can also try completing the forms on your smart phone or tablet and emailing them back to us.

ECP Form

Injury Report

Overseas Academic Programs Form

Sexual Health History Form

TST Administration Form

Urine Screening Form

 

Additional Forms:

The following forms are only to be completed if you choose not to complete the Health Report:

**Please download these forms to your desktop and complete them in Adobe. If you complete the forms in a web browser, they will not save properly. If completing the forms in Adobe is not possible, please print out the forms, complete them by hand and scan them back to us. There are many free scanner apps for smart phones you can utilize. You can also try completing the forms on your smart phone or tablet and emailing them back to us.

Demographics - Included in the Health Report

Health History - Included in the Health Report

Meningococcal Disease Fact Sheet

Meningitis Vaccination Response Form - Meningitis ACWY Vaccine must be given within 5 years of the start of classes. If your Meningitis Vaccine was given more than 5 years ago, please check the bottom box on this form in order to fulfill the requirement. Included in the Health Report

Minor Consent - Required only for students under the age of 18 years old, included in the Health Report

Tuberculosis Screening Questionnaire - Included in the Health Report

 

Additional Forms:

Allergy Questionnaire - Required only for students with allergies to foods/stinging insects. 

Asthma Questionnaire - Required only for students with a history of Asthma.

Immunization Records Request Form - For more info., please click the following link: Records Request

Leave of Absence Form - For more info., please click the following link: Leave of Absence

Release of Records From Student Health Service Records Request

Release of Records To Student Health Service 

 

Exemption Forms forms for MMR Requirements ONLY:

Medical Exemption Form for MMR Vaccinations

Religious Exemption Form for MMR Vaccinations