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.

Patient Portal

Please note that the patient portal becomes available to incoming students on June 2 for fall enrollees and on January 2 for spring enrollees. Please wait to register for the patient portal until after these dates.  

When registering, use your Hampshire College email address (e.g. xxx24@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, upload both forms. Required for intercollegiate sports: cross country, soccer, basketball, track and field)

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 (using your Hampshire email).  Blank forms are also available through the patient portal.

If you have any questions please contact our office at 413.559.5458 for assistance.

New Student Forms  

Due by July 15 or January 15:

Required Immunizations

-or-

Meningococcal Vaccine Waiver

Massachusetts Required Immunization Waiver

Tuberculosis Testing & History

  • ONLY if directed by Health and Counseling Services staff, 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

*New process as of July 15, 2024* 

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.
  • All 2024 new/transfer student athletes who have already completed and uploaded the sports physical form prior to July 15, do not need to provide additional documentation
  • 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.

Annual Physical Form for HC athletes