New Graduate and Professional Student Forms
Welcome to Yale Health! Please review the documents below for information about your health services requirements and deadlines for submission.
You will not be permitted to enroll in classes until all the forms are submitted and the immunization requirements are met.
- Vaccination Record for Incoming Students (due June 20, 2014)
- Health Form and Physical Exam (due June 20, 2014)
- Acknowledgement of Receipt of NOPP (due June 20, 2014)
- Waiver submission (only for students who want to waive parts of the coverage – available in June, deadline September 15, 2014)
- Student Allergy Medical Treatment Plan (only for students requiring on-going treatment by an allergist - due July 18, 2014)
- Student Enrollment/Change Application (for dependents and Affiliate plan)
Information for Review
- Notice of Privacy Practices (NOPP)
- Yale Health Student Handbook
- Student Rates (2014-2015 rates not yet available)
Contact our Member Services Department at firstname.lastname@example.org or 203-432-0246 if you have any questions or to discuss your options for health coverage.
We’re working together to get you off to a healthy start at Yale!