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Health Records are due once for incoming undergraduate and graduate students.
Insurance Selection and Reporting forms are due annually upon enrollment for each school year. They are due June 22 for students entering during the fall semester and Dec 1 for midyear students entering in January.
Forms
Massachusetts public health regulations require us to document, review, and update as needed the health and immunization status of our incoming students. These forms are due before your arrival on campus.
Insurance reporting and selection forms must be filled out each year by June 22 for students attending in the Fall semester and by Dec 1 for midyear students entering in January.
UNDERGRADUATE FORMS
Undergraduate forms
Undergraduate Health and Immunization Records
This form includes the required health history, immunization documentation, the Tuberculosis (TB) risk assessment, and the medical health physical form needed for entering undergraduate students. It is due before your arrival on campus.
Undergraduate 2013-2014 School Year Insurance Selection and Reporting Form This form is required annually for students attending school 3/4 and full time in Massachusetts and is due by June 22 for Fall admissions.
Release of Medical Information Form Complete this form to request information from your Brandeis medical record or to have your health records sent the Brandeis Health Center. Please note we need at least three business days to process these requests.
Meningococcal Waiver Form This form is also found in the incoming student health report packages.
Non Reportable Health Insurance Review/Appeal Form Complete this form to have your insurance reviewed if you believe you're insurance meets regulatory requirements and is comparable to the QSHIP but you are being told that your insurance is non reportable.
GRADUATE FORMS
Graduate forms
Graduate Health and Immunization Record This form includes the required health history, immunization documentation, and the tuberculosis (TB) risk assessment forms needed for entering graduate students. It is due before your arrival on campus.
Graduate 2013-2014 School Year Insurance and Reporting Form This form is required for all students attending school 3/4 and full time in Massachusetts and is due by June 30 for Fall admissions.
Release of Medical Information Form Complete this form to request information from your Brandeis medical record or to have your health records sent the Brandeis Health Center. Please note we need at least three business days to process these requests.
Meningococcal Waiver Form This form is also found in the incoming student health report packages.
Non Reportable Health Insurance Review/Appeal Form Complete this form to have your insurance reviewed if you believe you're insurance meets regulatory requirements and is comparable to the QSHIP but you are being told that your insurance is non reportable.