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Medical Services

Medical Forms

Health Form 2017

 

Send completed forms to:

Smith College Medical Services
21 Belmont Avenue
Northampton, MA 01063

healthservices@smith.edu
Fax: 413-585-4639

Health Services Entrance Form

Required for all first-year students

A completed Health Services entrance form, medical history, physical examination, Tuberculosis screening, and complete immunization records are required for all entering students.

Students who study abroad or otherwise take time off from their on campus studies are required to update the demographic and Tubercolosis screening portion of health forms upon return to campus.

 

In order to protect the health and safety of each student and our community, failure to provide all required documents will result in a HOLD being placed on student accounts. Students will be unable to pre-register for classes until all requirements are met. Please contact us with any concerns you may have about completing the forms.

 

Students having difficulty scheduling appointments or obtaining vaccines with their healthcare providers may find that walk-in urgent care centers and pharmacy clinics can provide required vaccines, screenings, and physicals. Vaccine finder tools can be useful in locating vaccine near you.

 

Medical Records Release Form

This release form is required to allow the transfer of medical information from Smith College Health Services to a secondary provider, such as your primary care provider at home or a referred provider.

Medical Release Form

Requests are done in the order in which they are received and may take up to two weeks to complete