Incoming Health Forms

Dear New Students and Families:

Welcome to the Mount Holyoke Community!

Mount Holyoke College requires certain health information be collected from newly matriculating students. This information is maintained in the confidential medical records at College Health Services and is needed for CHS to:

  1. best serve as your primary care health team while a student,
  2. support the health and safety of our entire College community, and
  3. to comply with College and Massachusetts regulations.

Details regarding the specific health requirements are outlined below as are the instructions to submit. ALL INCOMING STUDENTS ARE REQUIRED TO COMPLETE THE HEALTH FORMS NOTED BELOW.

Health Forms

  • Health history & PE forms
  • Immunization form signed by a medical provider or copy of immunization record (or medical or religious request for exemption for required vaccines)
  • (For varsity athletes only): additional NCAA sports forms

Incoming Student Health Forms are available for download on the patient portal, My Health Connection. You can log in with your MHC credentials, once you receive your MHC email address.

Completed health forms can be sent to Health Services via:

  • Email: medical-records@mtholyoke.edu; please include your initials and “new student health forms” in the subject line
  • Fax: 413-538-2352, or
  • Postal mail: MHC Health Services, Pattie Groves Health Center, 50 College St, South Hadley, MA 01075

Online Forms in the patient portal

  • Consent to treat
  • Confidentiality agreement
  • Billing agreement
  • TB screening questionnaire
  • Enter dates of required immunizations via the patient portal

These forms can be completed online via the patient portal, My Health Connection. You can log in with your MHC credentials, once you receive your MHC email address.

Health Insurance Info

  • Enrollment in MHC School Health Insurance Program (SHIP), or
  • Completed waiver and copy of student’s health insurance coverage

All MHC students are required to carry health insurance. The student insurance health forms, insurance waiver, and other materials are now available at the Gallagher insurance website. Unless your completed health insurance waiver is approved, you will be automatically enrolled in the Student Health Insurance plan.

Deadline for Forms

Health information is due by July 1 for students matriculating in the fall semester or January 1 for those matriculating in the spring semester. If your health requirements are not complete, your registration will be placed on hold.

Please also see our Frequently Asked Questions. If you still cannot find an answer, email questions regarding the health form requirements to: Health-Admin@mtholyoke.edu or phone Health Services (413-538-2121; during summer months messages can be left at 413-538-2089)

Immunizations

Frequently Asked Questions

What immunizations do I need?

Students are required to have immunity/completed vaccine series for the following infectious diseases:

  • Hep B – Hepatitis B (generally series of 3)
  • Tdap – Tetanus, diphtheria and pertussis (at least one within 10 years)
  • MMR – Measles, mumps and rubella (2 vaccines)
  • Varicella – Chickenpox (2 vaccines or clinician signed proof of having had chicken pox)
  • Meningitis A (within 5 years, or signed waiver)
  • Covid-19 (primary series and at least one booster)

Health Services strongly recommends students are vaccinated against these additional infections:

  • Meningitis B
  • Annual influenza vaccine
  • HPV 

If vaccines are not available in your country of residence, Health Services will be able to vaccinate you when here on campus.

What if I cannot get copies of my records?

If you know you have been vaccinated but cannot get copies of your vaccine records you have two options:

  1. you can get revaccinated and keep copies of the records, or 
  2. you can demonstrate immunity to some infections by a blood test.

A blood test called antibody titer can measure if you have adequate immunity to that infection (from having had the infection or from past vaccination). Titers are available and can substitute for immunizations for measles, mumps, rubella, varicella, and Hepatitis B. There are no titer substitutes for tetanus, pertussis, COVID-19, or Meningitis.

If you have proof of vaccination, you need not get titers drawn. But if you know you did have immunizations but cannot prove this, you can have the titers done at your local health care provider’s office and submit a copy of the blood test results instead. Students who do not meet immunization requirements prior to arrival on campus, can schedule an appointment at Health Services to receive missing vaccines or get titers drawn. There may be a charge associated with either of these procedures.

If the titers do not show immunity, however, you will be required to get vaccinated anyway.

What is the difference between the Td and TdaP?

Tdap is a combination vaccine that includes tetanus, diphtheria, and pertussis (whooping cough). You must have at least one dose of TdaP. Td is a booster vaccine for tetanus and diphtheria only. You must have a vaccine against tetanus within 10 years of entry to MHC. Booster doses tetanus vaccine is recommended for adults every 10 years. However, we strongly recommend your tetanus booster be given as a TdaP as there are outbreaks of whooping cough in recent years so the additional protection can help.

What if I do not have all of my documentation?

Students who do not have documentation of all required immunizations - or proof of immunity to those conditions - are considered out of compliance. Health Services will send reminders via email &/or the patient portal (My Health Connection) noting which requirements are missing or incomplete. You can also check vaccine compliance through the portal as well.

If you remain out of compliance and are not taking action to remedy that miss, Health Services may need to place a hold on your account which restricts certain College activities, like course registration, housing lottery. Holds not place or are removed when students actively are making progress toward vaccine compliance.

What if I have a medical or religious exemption?

Massachusetts law permits waivers for required vaccines due to medical reasons or strongly held religious convictions; it does not permit exemptions for philosophical or political beliefs.

Students who have a medical reason for not receiving an immunization must submit a completed Medical Exemption Request form that includes the specific vaccine(s), the reason for exemption request, and the details of the medical contraindication for each vaccine a waiver is requested. This form must be signed by a health care provider who is not related to the student.

Students for whom receipt of any required vaccine(s) violate their strongly held religious beliefs are asked to attest to this conflict by submitting a signed Religious Exemption Form. An approved religious exemption will hold for the duration of a student’s tenure at MHC. Those who are not yet 18 are asked to have a parent or guardian complete this form and this will need to be updated when the student reaches legal age. Students may update this exemption if/when their religious beliefs change.

Exemption request  forms can be sent via email (with subject line: “vaccine exemption request” and your initials) or fax: (413) 538-2352.

Does everyone need to be tested for tuberculosis?

All incoming students are required to complete the TB screening questionnaire in the patient portal. Those who have risks will need to have a blood test or skin test that screens for TB. 

Skin TB tests (PPDs) are only accepted from US or Canadian medical providers. Students from countries where TB is common can have a blood TB test (quantiferon gold or Tspot) performed and submit a copy of the test result to meet this requirement.  Otherwise, they will need a blood test during orientation. 

A chest xray is not needed nor will it serve as a sufficient screening test unless done following a positive TB skin or blood test.