Student Health Center

Health Records and Other Forms

Medical Record Release Form (PDF)

This form is to request copies of your medical records which are kept at Brandeis Health Center for 10 years. It can also be used (when signed by an adult student) to allow us to speak to a designated person who calls us for information about the student's health.  

Accessibility and Accommodation Forms

The Health Center does not directly provide accessibility accommodations for students but provides, as needed, a medical review and support for clarifying medically required accessibility and accommodation needs.

Housing Accommodation Application
The process for requesting and acquiring housing accommodations is managed by the Department of Community Living (DCL) with support from the Brandeis Housing Accommodation Review Committee. The DCL Accommodations page provides information on the process for requesting accommodations, as well as important timelines. Please visit the webpage for more details.
Parking and Dietary Accommodations

The process for Parking and Dietary Accommodation requests is managed through  Student Accessibility Support with the Parking and Dietary Review Committees. Please see its site for more information on these processes. 

For Incoming Students

All new, incoming students are required to complete a health report before arriving to campus.

Immunization Form-Sample Form of Required Immunizations
Sample of Online Tuberculosis Screening Questionnaire
Sample documentation for Tuberculosis Screening Tests-as needed

To be completed by a medical provider only with identified positive screening risks.

Sample Physical Exam-recommended

A physical done within six months is required for NCAA athletes (submit a copy to Athletics as directed) and is recommended for Health Services.

Waiver Forms

Medical Vaccination Exemption Request Form (PDF)
This form is for requesting an exemption from the vaccination requirements for medical reasons.
Meningococcal Waiver Form (PDF)

This form is for students under age 21 to provide informed declination of required Meningococcal vaccine (this is not recommended).

Religious Exemption Form

This form is for requesting an exemption from the vaccination requirements for religious reasons.