This is an online form that will be available in mid-June. 

Your completed Physical Assessment and Immunization Records (see below) will be helpful when completing this form. 

If you are living with a chronic illness, you may submit additional health information to assist with continuity of care. 

This is a form you must print and have completed and signed by your health care provider and mailed to UNH Health Services. 

First year students are required to have a physical exam upon entrance into the University. We understand that some students may have had a physical exam within the year and insurance companies will not pay for a second exam. If this is the case, please have your health care provider complete the Physical Assessment form with the date and information from your recent exam. If you do not have a current physical or physical appointment scheduled before the July 1st due date, late submissions will be accepted. Students intending to play a sport should contact their coach for specific physical date requirements.

Mail completed form to...
UNH Health Services
Health Records and Administration
4 Pettee Brook Lane
Durham, NH 03824

You may also drop the form off at Health Services. If we are closed, there is a "drop box" on the front door.

This is a form you must print and have completed and signed by your health care provider and mailed to UNH Health Services. 

Required and Recommended Immunizations:

• MMR (Measles, Mumps and Rubella)
  MMR is the only immunization that the University requires. It is the University's policy that all students be adequately immunized against MMR prior to attendance. Students must submit proof of two MMR vaccinations or, if the vaccinations were received individually, proof of two Measles, two Mumps, and one Rubella vaccination. Students born before 1957 are exempt from providing documentation.
• Meningococcal
  The American College Health Association (ACHA) recommends that college students consider vaccination to reduce their risk for potentially fatal meningococcal disease. In support of this recommendation, Health Services suggests you discuss the risk for meningococcal disease on campus with your medical clinician, and consider getting vaccinated. Ideally this would be done before coming to campus, but Health Services can provide the vaccine. An appointment can be scheduled with a Health Services nurse. Please note that vaccination against meningococcal disease is not a requirement for admission to UNH.    
• Letter from Medical Director about meningococcal disease
• FAQ meningococcal disease

• Hepatitis B
  We are strongly recommending that all students be vaccinated against Hepatitis B.

DOWNLOAD/PRINT FORM

Mail completed form to...
UNH Health Services
Health Records and Administration
4 Pettee Brook Lane
Durham, NH 03824

You may also drop the form off at Health Services. If we are closed, there is a "drop box" on the front door.

This is an online screening form that will be available in mid-June.  You will be asked to answer the following questions:

Were you born in a country with a high incidence of active Tuberculosis (TB) disease or have you… 

Have you…

• Been exposed to active TB disease, you are required to have your health care provider complete the “Tuberculosis Testing and Treatment” online form.
• Had frequent or prolonged visits to a country with a high prevalence of TB disease?
• Been a resident and/or employee of a high-risk congregate setting (e.g. correctional facility, long-term care facility, homeless shelter)?
• Volunteered/worked with clients who are at increased risk for active TB disease?
• Ever been a member of any a group that may have an increased incidence of latent M.tuberculosis infection or active TB? These groups include the medically underserved, low-income and abusers of drugs or alcohol.

If you answered “yes” to any of the above questions you are at increased risk for TB. You are required to print out the TB Testing and Treatment Form and bring it to your healthcare provider for further discussion and possible testing for TB.

The completed form must be submitted to Health Services prior to your arrival on campus.

This is an online form you must complete to indicate whether or not you will be enrolling in or waiving the Student Health Benefits Plan (SHBP).
 

The University of New Hampshire requires all full-time degree students to have adequate health insurance as a condition of enrollment. Proof of insurance is required at the beginning of every academic year. Students have the option of waiving the requirement if proof of adequate insurance through another plan is provided; or alternatively they can acquire affordable health coverage under a plan sponsored by the University and administered by Health Plans, Inc., a subsidiary of Harvard Pilgrim Health Care.
 

As part of this requirement, all full-time degree students must take some action - by either enrolling in the UNH Student Health Benefits Plan (SHBP), or requesting a waiver.

Permission to Treat Underage Student/Patient

ONLY FOR STUDENTS WHO ARE 17 OR UNDER

This form needs to be printed, completed and signed by the parent/legal guardian of students who are age 17 and under. The completed form should be mailed to Health Services.

DOWNLOAD/PRINT FORM 

Mail completed form to...
UNH Health Services
Health Records and Administration
4 Pettee Brook Lane
Durham, NH 03824

You may also drop the form off at Health Services. If we are closed, there is a "drop box" on the front door.

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