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The Office of Student HealthServices

Health Services Forms

All new students (Freshmen and Transfer) are required to submit their immunization record and the physical examination form to Student Health Services before attending classes. . It is preferable that you fax or email to us. Our email is and fax (914) 251-6388. Also, all new (Freshman and Transfer) students are required to complete the Meningitis Survey. To access the survey, please login and click on 'Student': myheliotrope

MMR Immunization Record (completed by health care provider or school/childhood record)

College Entrance Health History and Physical Examination
(completed by student and health care provider. A physical examination done within the past 18 months is required)

Additional forms (not required for new incoming students):

Athletic Forms

For Athletic Forms please see the Purchase Athletics website and click "Inside Athletics” —> “Required Athletic Forms and Policies”

Study Abroad Travel Forms