Health Forms for Students
**Health forms are due July 15 for the fall semester and January 15 for the spring semester. If the forms are not submitted, class registration and first-day move-in may be delayed.**
Required Forms
To complete the new student health forms, you will need to register for an account through the Hampshire / UMass patient portal.
When registering, use your Hampshire College email address (e.g. xxx25@hampshire.edu).
After logging into the patient portal, find the Hampshire Health and Counseling Clinic (option #6). Go to the “Forms” tab to access and complete these forms:
Required Forms:
- New Student Health Form (completed by new student)
- Immunizations Form (download from portal or link below, completed by health care provider, upload to portal)
- Tuberculosis Screening Form (completed by new student)
- Acknowledgment of Privacy Practices (completed by new student if over 18)
- Financial Responsibility Form (completed by new student if over 18)
Optional Form (for athletes only):
- Annual Physical (download from portal or link below, sign release of information, have provider complete, then upload both forms via the patient portal.)
Please keep in mind: If you do not have the chance to receive all required immunizations before the due date (July 15 for the fall semester and January 15 for the spring semester), please upload what you have, then contact the Health and Counseling office to make a plan.
Thank you for your assistance in meeting these College requirements. If you have any questions, please contact Health and Counseling Services at 413.559.5458.
Massachusetts state law requires that all college students are covered by health insurance. Hampshire College works with Arthur J. Gallagher & Co. to offer a student insurance plan that is tailored to the needs of our students. The Student Health Insurance Plan will be billed along with your tuition. If you have comparable medical coverage through another insurance plan, you can waive this fee.
Downloadable Health Forms
Please download the appropriate forms and have them completed by your medical provider.
Once completed please log into the patient portal to upload the forms.
You may also send health forms via USPS to 893 West Street, Amherst MA 01002; or fax forms to 413.559.5583
Blank forms are also available through the patient portal.
If you have any questions, please call our office at 413.559.5458 for assistance.
New Student Forms
Vaccine Waiver Forms:
Religious exemption - ImMUNization waiver form
MEDICAL exemption - ImMUNization waiver form
Tuberculosis Testing & History
- ONLY if directed by Health and Counseling Services staff, please print and have your healthcare provider complete this form.
- After the document is completed and signed by your provider, login to the patient portal and upload the document.
Athlete Forms
All Hampshire College athletes must have a yearly physical exam which must include provider recommendations / clearance for activities to participate in athletics at Hampshire College.
- Please download and print the below form and bring it to your healthcare provider to complete.
- Please upload the documentation via the PATIENT PORTAL, send via USPS to (893 West Street, Amherst MA 01002) or fax to 413.559.5583.
- If you have not had an annual exam at home in the past 12 months, you may be eligible to receive one at Hampshire Health and Counseling Services.