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

Immunization Record:

• Please complete and submit the Immunization Record
• Immunization requirements apply to all students born on or after January 1st, 1957 including part-time, non-degree seeking and RIT Staff.
• Immunizations must be submitted prior to your arrival on campus and must be in English.
• New York State law requires students born on or after January 1st, 1957 and enrolled for six or more credits to supply the following immunization information:
  • Dates of 2 MMR (Measles, Mumps & Rubella combined) shots or equivalent individual vaccines.
  • An electronically signed meningococcal meningitis awareness form.
• If you are 21 and under, you must supply proof of a meningococcal meningitis vaccine verified by your health care provider or school official.
• After submitting the online Immunization Record, you will receive an Immunization Verification form via e-mail. Your registration is not complete until the verified (by a health care provider or school offical) copy of your immunizations is received and approved by the Student Health Center staff.

• Please complete and submit the Health History Form.
• Health History must be submitted prior to your arrival on campus.
• 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.

• Please complete and submit the Tuberculosis Screening Form.
• You may receive additional information via e-mail based on your responses to the screening form.

• Please complete and submit the Insurance and Treatment Authorization Form.
• All students are required to carry health insurance coverage through family coverage, a personal policy, or through the RIT sponsored plan.

SUBMIT EARLY FOR A CHANCE TO WIN $150!
You will be entered in a raffle for a $150 gift card from Barnes and Noble if your verified immunizations are received before July 1, 2013.

Additional Forms Available For Download