New Undergraduate 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 July 3, 2015)
- Health Form and Physical Exam (due July 3, 2015)
- Waiver submission (only for students who want to waive parts of the coverage – available in June, deadline September 15, 2015)
- Authorization for Medical Care and Treatment (only for students under the age of 18)
- Student Allergy Medical Treatment Plan (only for students requiring on-going treatment by an allergist - due July 18, 2015)
- Varsity Athlete Required Forms (only for intercollegiate athletes – due July 3, 2015)
- Student Enrollment/Change Application (for dependents and Affiliate plan)
- Designation of a Personal Representative to Access Health Information
Information for Review
- Notice of Privacy Practices (NOPP)
- Yale Health Student Handbook
- Student Rates (2014-2015 academic year)
- NCAA ADHD Medical Exception Reporting Form
- NCAA Sickle Cell Trait Guideline
Contact our Member Services Department at email@example.com 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!