Forms

Immunizations and Vaccinations

Please review the Immunization and Vaccination Requirements and your WIReD My Enrollment Checklist before submitting any of the following forms.

If you need official copies of vaccination records, see the CDC's How to Locate Your Vaccination Records webpage.

Other Forms

  • Authorization for Disclosure
    This form should be completed when requesting Health Services to release your immunization records. This form allows the college to release immunization, treatment, laboratory and physical exam records as necessary.
  • Health Science Physical Form (PDF)
    Required for students in the following programs: Early Childhood and Health Science Students, including: Dental Hygiene, Diagnostic Cardiac Sonography, Diagnostic Medical Sonography, Invasive Cardiovascular Technology, Mortuary Science, Nursing, Paramedic, Respiratory Care, Radiologic Technology and Surgical Technology.
  • Student-Athlete Health Forms
    Required for all student athletes.
  • Documentation of COVID-19 Test Results
    Students and employees should use this form to submit documentation of their COVID-19 test results, including clearance from county health departments.

When Being Seen/Treated in Health Services

Students and employees may be asked to complete the following forms when being seen in Health Services.

Get in Touch

Health Services

Siek Campus Center, Suite 270

Fax: (518) 629-7471

Office Hours: Monday - Thursday: 8 a.m. - 5 p.m.; Friday: 8 a.m. - 4:30 p.m.

Summer 2024 Hours (May 20 - July 26): Monday – Thursday, 8 a.m. – 4 p.m.; Friday, Closed