Required Student Health Forms

Required Medical Forms

• Online Undergraduate Form FALL 2012 Students are eligible to complete the form AFTER May 21, 2012 (Summer 2012 students can complete the form now.)
• Online Graduate Form FALL 2012 Students are eligible to complete the form AFTER May 21, 2012 (Summer 2012 students can complete the form now.)
• Online Disability Services Request Form - Complete this form only if you have a disability (e.g., learning disability, vision/hearing impairment, physical disability). Please contact Disability Services at 716.286.8076 or ds@niagara.edu for more information.

Additional Forms

• Physical Form & TB Screen
• Meningococcal Vaccines informational flyer
• Graduate Students Only: Meningitis Response and TB (Tuberculosis) Screening
• Authorization for Disclosure for Health Information
• Allergy Shots
• Waiver for Age Exemption to Immunization
• Waiver for Medical Exemption to Immunization

New York State Public Health Laws 2165 and 2167 mandate that all students taking more than six (6) credit hours and born after 1/1/1957 provide proof of immunization coverage. The following information is required to be turned into Health Services prior to the start of your classes.

• Documented proof of two MMR vaccinations. The first dose must have been received four days prior to or after your first birth date.
• Documented proof of the Meningococcal meningitis vaccination or a signed waiver stating you decline the immunization and understand the risks.
• Completed medical form with physical examination for all undergraduate students (dated within one year prior to entering classes).
• Complete NU Online Disability Services Student intake form if applicable.
• International Students are required to submit proof of adequate insurance.

For your convenience Health Services does offer physical examinations and the MMR immunizations from September through May. To schedule an appointment for any of these services please call the Student Health Center at 716.286.8390. Our current fee schedule is found below:

• Measles, Mumps, Rubella vaccination: $50
• PPD for TB Testing: $15
• DTaP vaccination: $35
• Physical Examination: $75

The above information is due to the Student Health Center 30 days prior to your first day of class. Students who do not submit the required information will be excluded from class, the residence halls and prohibited from further registration at Niagara University per university policy. Feel free to contact Student Health Center at 716.286.8390 should you require assistance.