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Health Forms for New Students

Health forms are due July 1 for fall semester and January 15 for spring semester.

Please refer to the checklist below in order to submit all of the necessary completed information. If you don't turn in health forms, your class registration and first day move-in will be delayed.

  1. New Student Health Form PDF (completed by student)
  2. Immunization and Tuberculosis Screening Form PDF (completed by health care provider)
  3. Sports Health and Physical Forms PDF (optional, required only if you intend to participate on an intercollegiate sports team: cross country, soccer, and basketball teams)

Forms may be returned by mail (Hampshire Health and Counseling Services, 893 West Street, Amherst, MA, 01002; fax (413.559.5583), email attachment (healthservices@hampshire.edu), or in person.

Thank you for your assistance in meeting these College requirements. If you have any questions, please contact the health and counseling services at 413.559.5458 or healthservices@hampshire.edu.

Massachusetts state law requires that all college students are covered by health insurance. Hampshire College works with the Gallagher-Koster company to offer a student insurance plan through Harvard Pilgrim 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 between July 1-August 10.

Healthcare Proxy Forms

Students are encouraged (but not required) to complete and send an Advanced Directive Form and Healthcare Proxy (pdf). Advance directives are legal documents that protect your right to refuse medical treatment you do not want or to request treatment you do want, in the event you lose the ability to make decisions yourself. A healthcare proxy form lets you name someone to make decisions about your medical care--including decisions about life support--if you can no longer speak for yourself. An advance directive is legally binding only if the person completing it is a competent adult, at least 18 years old.

Forms

New Student Health Form (required)

Immunization and Tuberculosis Screening Form (required)

Sports Health and Physical Forms (required for intercollegiate sports, otherwise optional)

Advanced Directive Form and Healthcare Proxy (optional)

Confidentiality

Students should read the Notice of Privacy Practices (pdf)  to understand health and counseling services' commitment to patient privacy and confidentiality.

Stay In Touch
With Health and Counseling Services
Snail Mail
Health and Counseling Services
Hampshire College
893 West Street
Amherst, MA 01002
Phone + Email