Health Forms and Requirements
Medical Clearance
All students are required to complete and submit health forms and immunization documentation prior to the first day of classes for each semester. Students must meet New York State immunization requirements and the Health Services Center standards.
- A completed Health History and Assessment form.
- Completed Immunization Requirements:
- Measles, Mumps and Rubella (MMR) Immunization Requirement Form is Part B of the Complete Health and Immunization Forms.
- Meningococcal Vaccination Response Form is Part D of the Complete Health and Immunization Forms.
How To Submit Your Documents
- Email: healthservicescenter@adelphi.edu
- Fax: 516.877.6008
- Mail: Send copies of your records to the following address:
Adelphi Health Services Center
Waldo Hall
1 South Avenue
Garden City, NY 11530
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 Medical Clearance
All Adelphi students participating in student teaching must meet health clearance requirements prior to their on-site attendance.
Health Forms
- 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.) - Declination of Hepatitis B Vaccine Form (PDF)
- Release of Patient Health Information Form (PDF)
- Influenza Vaccination Form (PDF)
- Athletic Clearance (PDF)
Patient’s Bill of Rights
As a patient at the Adelphi University Health Services Center, you have certain rights and responsibilities.
Adelphi needs proof of required immunization for medical clearance. If you do not comply with the New York State mandated immunization standards. You will not be allowed to attend class and may be withdrawn from the University.
Students enrolled in fully online programs are not required to provide immunization records. If at any time this status changes and the student begins on-site classes, they will be required to provide proof of all necessary immunization requirements.
