Health Services Forms and Information

  • Massachusetts law requires all college students to have a physical examination and submit a health form with evidence of immunizations, medical history, etc. Have your physician complete the required health forms below and return them to the Dean College Health Services Center.
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      Required Health Forms


      Required Health Forms Packet

      The Dean College Health Form must be completed by the student or, when indicated, by the parent/guardian. It includes student demographics, contact information, insurance information and authorization and consent for treatment at Dean College Health Services and its affiliate providers. The Required Health Forms packet also includes a certificate of immunization, physical exam form, tuberculosis screening questionnaire and a meningitis waiver form.

      If a student has appropriate health insurance coverage, the information should be noted on the Health Form. A copy of the student's insurance card, both sides is also requested. All students are automatically enrolled in and charged for the Dean College Student Health Plan unless proof of comparable coverage is provided AND an on-line waiver form is completed. More information regarding health insurance requirements can be found under the Health Insurance link.

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      Physical Examination Form


      Physical Examination Form

      A physical exam is required of all new and transfer students admitted to Dean College. The Dean College Physical Examination Form must be completed by the student’s medical provider and returned to Health Services prior to arrival on campus. The physical exam must be within the last 12 months of starting classes at Dean College. Athletes are required to have an annual sports physical exam and will be unable to participated in any sport without proper documentation. The sports physical must state that they are able to participate in all athletic activities connected to that sport.

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      Certificate of Immunization


      Certificate of Immunization

      The Dean College Certificate of Immunization form must be completed by the student’s medical provider and returned to Health Services prior to the start of classes. If a student's immunization record is not updated or has been lost, then appropriate blood work to determine immunity can be done by the student’s medical provider.

      Massachusetts State Law requires that all new incoming students, both new and transfer students in undergraduate and graduate programs, provide a “certificate of immunization” to the College. This certificate should demonstrate compliance with the immunizations required by state law. These immunizations include:

      •      Hepatitis B - 3 doses
      •      Measles, Mumps, Rubella (MMR)   - 2 doses
      •      Tdap (Tetanus) in last 10 years
      •      Meningitis vaccine within the last 5 years
      •      Varicella - 2 doses or medical documentation of disease
      •      PPD for high-risk and international students


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      Meningitis Vaccine


      Important Meningitis Vaccine Information and Waiver

      To further protect the health of college students, Massachusetts State Law requires the meningitis vaccine for all newly enrolled and transfer students living in a college residential setting. It is recommended that students receive this vaccine prior to the start of classes. State law mandates that documentation of immunization against meningitis must be provided within 30 days of registration. The law also allows for students and/or parents to waive receiving the vaccine.

      In conjunction with the Massachusetts Department of Public Health (DPH), we are providing important information regarding the risks of meningococcal disease and recommendations regarding the meningitis vaccine.  This information is available in the Meningococcal Disease and Vaccination AND Waiver form.

      If, after reviewing this important information, you decide not to receive the meningitis vaccine, you may sign this official waiver of exemption and submit the hard copy to Health Services.  

      If you need further information regarding this Massachusetts legislation, you may refer to www.mass.gov/dph.

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