Health Services

Health Services Forms

All new (Freshman and Transfer) students are required to submit their immunization record, Meningitis Response Form and the Physical Examination Form to Student Health Services. It is preferable that you fax or email to us our email is  hse@purchase.edu and fax (914) 251-6388.

All new (Freshman and Transfer) students are required to fill out the Meningitis Survey. To access the survey, please login and click on 'Student': myHeliotrope

Immunization Record Form (the immunization record does not have to be on our form)

Physical Examination THIS IS A REQUIRED DOCUMENT FOR ALL NEW STUDENTS (FRESHMAN AND TRANSFER) If you have had a physical exam within the past 18 months you do NOT need to get another one. Have your doctor fill out the form using the information on your past physical.

Women's Health Questionnaire

Men's Health Questionaire

Medical Leave of Absence Reenrollment Form

Medical Leave of Absence Information Form