Forms for New Undergraduate Students
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.
Instructions
Required Forms
- Vaccination Record for Incoming Students (due July 20, 2011)
- Health Form and Physical Exam (due July 20, 2011)
- Acknowledgement of Receipt of NOPP(due July 20, 2011)
Other Forms
- Waiver submission (only for students who want to waive parts of the coverage – available in June, deadline September 15, 2011)
- 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 treatmenty by an allergist)
- Intercollegiate Athlete Medical Form (only for intercollegiate athletes – due August 2, 2011)
- Student Enrollment/Change Application (for dependents and Affiliate plan)
Information for Review
- Notice of Privacy Practices (NOPP)
- Student Guide to Yale Health
- Yale Health Student Handbook
- Student Rates
- NCAA ADHD Guideline
- NCAA Sickle Cell Trait Guideline
Contact our Member Services Department at member.services@yale.edu 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!
