Student Forms

New Student Health Form

Please note that this packet must be completed and returned to UMS prior to your arrival to campus. Note the required proof of measles immunization in section 3 and the required Meningitis and Hepatitis B Vaccination Status Form in section 9 (this particular item is also available online below).

New Student Health Form

Request for copy of your medical information

You can request a copy of your entire medical record or just a certain part, such as your immunization records (most students just need this part of their record). There is a $5 charge for a copy of your entire record but no charge for copies of immunization records only.

Request for copy of your medical information

Authorization for releasing protected health information

As a courtesy to you, UMS has provided this authorization form so that, in the event that you become ill or need assistance with your health care decisions, your permission may be given ahead of time to discuss your health care with persons you designate, such as parents, guardians, or personal representatives.

Authorization for releasing protected health information

Meningococcal and Hepatitis B Vaccination Status Form

SPECIAL NOTE: If you are planning to stay in the residence halls, you must complete this form. You are not required to have the vaccination but you must disclose your vaccination status.

Meningococcal and Hepatitis B Vaccination Status Form