Health Services Forms and Requirements
Making sure everyone at Adelphi stays healthy.
Please be advised of the mandatory immunization requirements for Measles, Mumps, and Rubella and Meningococcal Disease (Meningitis) Immunizations must be met prior to the first day of classes for each semester!
Due to the COVID-19 outbreak, we are currently requesting that all students upload their forms unless there is an extenuating circumstance in which they must provide a hard copy. Forms can be uploaded to the Health Portal located on eCampus, or emailed to firstname.lastname@example.org.
- Complete Health and Immunization Forms (PDF)
(includes Health History and Assessment, MMR Immunization Requirement Form and Meningococcal Meningitis Vaccine Response Form.)
- Annual Health History and Physical Form (PDF)
(Part C of the Complete Health and Immunization Forms. This form must be re-submitted annually by students in certain programs prior to beginning field work, including nursing students in clinical rotations and education students working in schools.)
- Meningococcal Meningitis Vaccine Response Form (PDF)
(Part D of the Complete Health and Immunization Forms.)
- Declination of Hepatitis B Vaccine Form (PDF)
- Release of Patient Health Information Form (PDF)
- Influenza Vaccination Form (PDF)
- Allergy Injection Form (PDF)
- Athletic Clearance (PDF)
Health Insurance is mandatory for all residential and international students. Students may elect to enroll in Adelphi’s school insurance or waive the school insurance in favor of another comparable policy. Commuter students may voluntarily elect to enroll in school insurance but are not required to do so.
The Adelphi Health Services Center provides the medical clearances for all students traveling abroad. A nurse practitioner will review your assessment forms, and can perform an exam and administer required immunizations.
Athletic Clearance Requirements
Every Adelphi student athlete is required to be seen by the Nurse Practitioner in Health Services for their final clearance to play collegiate sports. This appointment allows the practitioner to review the student’s health history, perform an EKG and discuss Sickle Cell testing.
Student Teaching Clearance
All students participating in student teaching must meet health clearance requirements prior to their site attendance.
Patient’s Bill of Rights and Responsibilities
As a patient at the Adelphi University Health Services Center, you have certain rights and responsibilities.