Health Forms

Deadline

The deadline for all forms is December 1st.

Online Forms

Please complete the online forms on MyHealthConnection by logging in with your MHC credentials and then complete the online forms:

• You will be asked to review and acknowledge billing practices, consent to treat, and our confidentiality statement. If you are younger than 18 when you matriculate, you will need to also download and complete the "consent to treat" paper form and have a legal guardian sign.
• TB Screening Form - complete this form online - if you have any yes responses you will be directed to review the TB testing form for additional tuberculosis testing requirements.

• Immunization Dates - enter your immunization dates into the portal - AND you will then upload the completed immunization form (downloadable from the tiles below) signed by your medical provider or an official copy of your immunization records so dates can be verified.

Downloadable Forms (see below)

All students must complete and submit a health history form and get a physical exam signed by a medical provider (MD, DO, NP, or PA) These forms are downloadable in the tiles below.

Additional forms (for select students)

• Varsity athletes must meet all health requirements prior to their participation in pre-season activities. NCAA has additional health requirements which are detailed in the form attached below.

Final Step

Please upload your completed health forms via the patient portal: MyHealthConnection using the medical records link. This is the most secure way to submit your personal health information.

...

Only if you are unable to upload your health forms, you may alternatively send the forms to Health Services via the following methods, in order of preference:

• Email: medical-records@mtholyoke.edu; please include your initials and "new student health forms" in the subject line
• Fax: 413-538-2352, or
• Postal mail: MHC Health Services, Pattie Groves Health Center, 50 College St, South Hadley, MA 01075