Required Student Health Forms

Student Health Services is committed to maintaining a safe and healthy campus. Here you will find the required student health forms to ensure compliance with New York State Public Health Laws 2165 and 2167. These laws apply to ALL students. All required documents are due prior to the start of your classes.

Niagara University strictly enforces abidance with these laws. Students who do not submit the necessary information within 30 days of their first class will have a hold placed on their student account. After 60 days, their registration will be withdrawn. Withdrawn students cannot attend class, reside in college housing, access college technology, participate in or attend campus events.

Print and Submit Medical Forms

In person drop off: Located on campus in the Butler Building, if before or after hours a secure locked box is outside of the front door for paperwork drop off.

Fax: 716.286.8391

Mail:
Student Health Center
P.O.Box 1923 Butler Building
Niagara University, NY 14109

**Due to HIPAA regulations, we are unable to accept any health forms by email**

Required Medical Forms (Print and Submit)

Please submit a copy of the front and back of your current Health Insurance or Health Card along with your required medical forms. This copy is for Health Services records only, you will still need to follow the instructions on the Student Health Insurance page to waive/enroll in the insurance when it becomes available in July.

Additional Forms

Students who are under 18 years of age at the beginning of the Fall semester must fill out the Consent for Treatment of a Minor form to be seen and treated at Student Health Services.

Consent for a Treatment of a Minor

Authorization from a medical provider disclosing health information, if necessary.

Authorization for Disclosure of Health Information