Health Records and Other Forms
Waiver Forms
This form is for students under age 21 to provide informed declination of required Meningococcal vaccine (this is not recommended).
This electronic submission form is for requesting an exemption from the vaccination requirements for religious reasons. The form will be reviewed by a team of Brandeis administrators. The student will receive notification of approval or denial via your Brandeis email.
This form is to request copies of your medical records which are kept at the 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.
An electronic version of this form is available in the Secure Patient Portal under the Forms tab.
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.
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.
Sample Forms
To be completed by a medical provider only with identified positive screening risks.
A physical done within 12 months is required for Brandeis first year undergraduate students.