University of Rochester

Contacting the UHS Health History Form Office

By e-mail

By phone *

By fax
585-756-0263 (Note: The Health History Form cannot be faxed.)

By mail
University Health Service-HHF
Box 270617, 738 Library Road
Rochester, NY 14627

* When leaving a phone message, please spell the student's name. Give the student ID # and birth date and e-mail address and/or daytime phone.

Please send questions about the technical structure/operation to the UHS Web Master

Last modified: Monday, 13-Mar-2017 15:13:57 EDT

University Health Service (UHS)

Health History Form
& Immunization Requirement

The Health History Form is used to document immunizations, as well as the student's current and past medical history. All required immunizations must be documented on the form, which is due before the start of classes. New York State law mandates that students not in compliance with the requirements 30-45 days after the start of classes be withdrawn from school and required to leave campus. A late fee will be charged if the requirements are not met by the deadline.

Entering students receive their Health History Form in their enrolling student packet after they have accepted admission to the University. Students who cannot receive the immunizations before arriving on campus can receive their immunizations at the University Health Service (UHS). There is a charge for the visit and the immunizations received.

Immunization Requirements & Forms

New York State Public Health Law #2165 requires all full-time and part-time (enrolled for at least six credit hours per semester or four credit hours per quarter) students born on or after January 1, 1957 attending a college or university in New York State provide documentation of immunity to measles, mumps, and rubella before they can attend college in New York. New York State Public Health Law #2167 requires colleges and universities to provide information about meningococcal meningitis (also called meningococcal disease) and vaccine availability to students. See the Meningococcal Disease Information Sheet.

In addition to the New York State requirements, the University of Rochester requires all full-time students to be immunized for polio and tetanus/diphtheria (Td) immunization. The tuberculin skin test is required for students from countries with a high incidence of tuberculosis. (Click here for the list of countries.) Students entering specific programs (e.g., health professions) may have additional requirements, including annual influenza vaccination.

For additional information about the Health History Form requirement:

For more information, contact the UHS Health History Form Office at or (585) 275-0697. If you are an incoming medical student, call (585) 275-4955.