Health Records and Other Forms

This form is to request copies of your medical records which are kept at Brandeis Health Center for 10 years.

For Incoming Students

All incoming students are required to complete a health report once upon matriculation.

Students will need to have their health care provider complete and sign the required health records.

To be completed by a Medical Provider only with identified positive screening risks.

A Physical done within six months is required for NCAA athletes (and is submitted to Athletics separately on your own) and is recommended for Health Services.

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 accommodations are initiated and processed through the department of community living. If a medical review of health records is required the medical housing accommodations form must be submitted to the health center for review and possible consultation with the listed provider(s). A committee meets periodically during the year to review how to best meet medical housing needs on campus. 

Dining Services accommodations occur through Sodexo Dining Services.  Bring this form with you to your initial meeting with dining services (contact Karen Jew).

If it is determined, after your initial meeting with Dining Services, that further accommodations are needed or clarification of medical needs is requested, both you and your provider(s) must complete and submit the medical dietary need form to the Health Center for review. A committee convenes regularly to determine how to best meet medical dining needs on campus.

Parking/Transportation Accommodation Application

Parking accommodations are provided through the Parking Office at Public Safety. To request an accommodation, please submit the Parking/Transportation Accommodation Application (available at the Public Safety Parking Office) to either the Parking Office in Stoneman Building, 781-736-4250, or Student Accessibility Support (SAS) in Usdan East, 781-736-3470. Medical documentation to support a parking accommodation request is required and should be submitted to the Health Center.

Waiver Forms

This form is for students living on campus to provide informed declination of required Meningococcal vaccine (this is not recommended).