Student Health Center Electronic Health Forms
Electronic Health Forms - Required from ALL Students
The Student Health Center requires all students to submit health information electronically. This information is required to complete your registration to RIT.
Four forms must be submitted to the Student Health Center:
- Immunization Record
- Health History Form
- TB Screening Form
- Insurance and Treatment Authorization
- After submitting the online Immunization Record, you will receive a Physician Verification form (via e-mail) which must be signed by your physician. Your registration is not complete until this form is received and approved by the Student Health Center staff.
Health History Form
- This form provides the Student Health Center a detailed history of your past physical and emotional health and allows us to personalize your health care.
Tuberculosis Screening Form
- You may receive additional information via e-mail based on your responses to the screening form.
Insurance and Treatment Authorization Form
- All students are required to carry health insurance through family coverage, a personal policy, or through the RIT sponsored plan. The plan must provide coverage while the student resides in Rochester, New York.
- If you will be enrolling in the RIT sponsored plan, please enter "RIT Aetna" in the Medical Insurance Company textbox.
The Student Health Center staff is ready to assist you with any questions or concerns that you may have. Please contact us at firstname.lastname@example.org or 585-475-2255.
Additional Forms Available For DownloadAuthorization for Release of Protected Health Information (PHI)
Request for Religious Exception to Immunization