Records for students matriculating in the Fall of 2015 are due by July 25, 2015.

Health Forms

Health Records are required once, upon matriculation into a degree granting program. These records allow us to meet state public health regulations as well as inform your medical care as a patient of Brandeis Health Center. Your records are kept as confidential health records. Records may be downloaded and sent via mail service directly to the health center at 415 South Street MS034, Waltham, MA 02454 or via our dedicated fax line at 781-736-3675.

Complete Undergraduate Health Record

Complete Gateway Health Record

Complete Graduate Health Record

Meningococcal Waiver Form

General Agreement Form

Patient Rights and Responsibilities

Notice of Privacy Practices -note this applies only to records after August 2015. Prior records are kept in paper format at Brandeis Health Center and can be requested using the following form:

Medical Record Request Form -for records prior to August 1 2015.