Student Health Questionnaire

• Upload your official immunizations record OR Health History Form under ‘document upload’ and complete your Student Health Questionnaire on your Student Health Portal.
• This form is required for all campuses EXCEPT:

• • Students at the School of Law – contact your school regarding immunization requirements
  • Students at the Medical, Dental or Graduate schools at UConn Health in Farmington – should contact your school for health history requirements as they may differ from those stated here

• Deadlines: Your required immunization documentation and Student Health Questionnaire must be submitted prior to attending orientation. 
• NOTE: Apple Preview should not be used to complete this PDF

Authorization for Release of Health Information

• To obtain a copy of your medical record from Student Health and Wellness please complete the Authorization for Release of Health Information Form. The form can then be faxed or emailed to address noted on the top of the form.

Clinical & Field Placement Student Health Record

• In addition to the Student Health History Form, students on Clinical Rotations are required by practice sites to provide specific information about their current health and immunization status.
• Students in clinical programs may have additional vaccine requirements beyond the university requirements. Additional details can be found at the Office of Clinical Placement Coordination.
• Clinical Students requiring copies of their immunization record or lab test results, may access these records on their Student Health Portal under 'My Profile'

Non-Responder Form

• Non-Responder Form for Student Clinical Placement or Other Experiential Learning Experience.

Immunization Exemption Form

• If you require a medical exemption from the university’s immunization requirements please print, complete and upload this form to your student health portal. Please note that medical exemptions subjects you to exclusion from campus in the event of a vaccine-preventable disease outbreak. 
• The university will only permit vaccination waivers for medical reasons. A signed statement indicating specific medical contraindication from your medical provider is required for medical exemption.

Club Sports Participant Clearance to Play Form

• All Club Sports athletes will be required to fill out a Clearance to Play form. Participants must have the signature of their healthcare provider verifying they have had a physical examination within one year of the season’s start date.

Student Health Questionnaire

• Upload your official immunizations record OR Health History Form under ‘document upload’ and complete your Student Health Questionnaire on your Student Health Portal.
• This form is required for all campuses EXCEPT:

• • Students at the School of Law – contact your school regarding immunization requirements
  • Students at the Medical, Dental or Graduate schools at UConn Health in Farmington – should contact your school for health history requirements as they may differ from those stated here

• Deadlines: Your required immunization documentation and Student Health Questionnaire must be submitted prior to attending orientation. 
• NOTE: Apple Preview should not be used to complete this PDF

Authorization for Release of Health Information

• To obtain a copy of your medical record from Student Health and Wellness please complete the Authorization for Release of Health Information Form. The form can then be faxed or emailed to address noted on the top of the form.

Clinical & Field Placement Student Health Record

• In addition to the Student Health History Form, students on Clinical Rotations are required by practice sites to provide specific information about their current health and immunization status.
• Students in clinical programs may have additional vaccine requirements beyond the university requirements. Additional details can be found at the Office of Clinical Placement Coordination.
• Clinical Students requiring copies of their immunization record or lab test results, may access these records on their Student Health Portal under 'My Profile'

Non-Responder Form

• Non-Responder Form for Student Clinical Placement or Other Experiential Learning Experience.