Health Forms

Health Record Requirements

Health Record packets will be mailed early May and December

ALL new full time students, whether entering as a freshman or transfer, must provide the following information to Health Services. It is preferred you return the forms mailed to you; however, if you are copying forms off the web, the following forms must be submitted: Health Record (pg. 1), Student Health History (pg. 2), Physician Physical Exam (pg. 3), and Immunization Record (pg. 4)

Keep the PINK copy of the forms for your own records, and mail forms back to the college, Attn. Health Services/Athletic Department.  Do not send attachments. Please fill in page 3 (Physician Physical Exam) and page 4 (Immunization Record) and have physician sign and date at time of physical exam.

CHECKLIST:

  • Review the Tuberculosis At Risk Countries. Review the Meningitis Information Waiver Flyer and Meningococcal Disease and College Students.

  • PHYSICAL EXAM COMPLETED AND SIGNED BY PHYSICIAN.

    • It is recommended you receive this physical within 6 months of your entrance to Nichols College. Transfer students may submit a copy of their Health Record from previous college, but must still complete pages I and 2 of Nichols College Health Record and ensure immunization requirements are met. Transfer students that are participating in intercollegiate sports must have physical exam within 6 months of entrance to Nichols College.

  • IMMUNIZATIONS ARE UP TO DATE AND REQUIREMENTS MET.

    • Tetanus/Diptheria (TD) – A booster of TD is required every 10 years or TDAP within 5 years for Freshmen.
    • Measles, Mumps and Rubella (MMR) – Immunization with 2 doses at or after 12 months of age. See Immunization Record for more information.
    • Hepatitis B Series – 3 doses of Hepatitis B
    • Tuberculosis (TB) – See information on the Immunization Form, refer to Tuberculosis At Risk Countries Form as needed.
    • Meningitis
      • FULL TIME RESIDENTIAL STUDENTS: Please review the attachment, Information about Meningococcal Disease and  Vaccination and Waiver for Students at Residential Schools and Colleges and comply with vaccination requirement.
      • ALL STUDENTS: Please review the Meningococcal Disease and College Students attachment.
      • The new meningococcal requirement is as follows: All newly enrolled full time students 21 years of age and younger must have received a dose of quadrivalent meningococcal vaccine (MenACWY) on or after the 16th birthday. Students may submit a medical or religious exemption to meningococcal vaccine, or sign the attached waiver indicating they reviewed the meningococcal information sheet and choose to waive receipt of meningococcal vaccine. The attached waiver form has been updated to reflect the new requirements and the latest recommendations on meningococcal vaccine. Please note that meningococcal B vaccine does not fulfill the meningococcal requirement
    • Varicella – Please be sure your physician fills in the information regarding chicken pox. If you have never had chicken pox it is strongly recommended you be vaccinated.2 Doses required for Freshman

  • ATHLETES

    • Please be sure to fill out Health Record in its entirety and provide information on all sports related injuries or accidents you have been involved in. Also list any restrictions you may be under.
    • PLEASE SEND ENTIRE COMPLETED RECORD TO NICHOLS COLLEGE.
      If you will be participating in a FALL sport, please send forms directly to the Athletic Department. Return envelope provided. Please check the Athletic Department. All other athletes send to Health Services.

  • HEALTH INSURANCE

    • Massachusetts General Law Chapter 15A, section 18 requires all students enrolled in 9 or more credits be covered by health and accident insurance. Please provide a copy of the front and back of your insurance card along with any secondary insurance you may carry.

  • QUESTIONS

    • Call Health Services at 508-213-2238 or Student Services at 508-213-2480. Athletes with questions can contact the Athletic Department at 508-213-2183.

  • MAIL COMPLETED PACKET

Office of Health Services (or Nichols College Athletics – IF FALL ATHLETE)
Nichols College
PO Box 5000
Dudley, MA 01571

DO NOT GIVE TO ANY OTHER DEPARTMENT.  DO NOT BRING TO ORIENTATION.