Required Student Health Forms
Required Medical Forms
- Online Undergraduate Form (please use your purple pass to sign into your electronic medical record)
- Online Graduate Form (please use your purple pass to sign into your electronic medical record.
- Online Disability Services Request Form - Complete this form only if you have a disability (e.g., learning disability, vision/hearing impairment, physical disability, food allergy). Please contact Kelly Englert at Disability Services at 716.286.8541 or firstname.lastname@example.org for more information.
- Physical Form & TB Screen
- Immunization Requirements Form
- Meningococcal Vaccines waiver
- TB questionnaire
- Authorization for Disclosure for Health Information
- Allergy Shots
- Waiver for Age Exemption to Immunization
- Waiver for Medical Exemption to Immunization
- Waiver for Religious 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 no sooner than four days prior to 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 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.
The above information is due to the Student Health Center 30 days prior to the beginning of the semester.
Important - Please Review
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 the Student Health Center at 716.286.8390 should you require assistance.