Required Forms

• College Entrance Health History and Physical Exam form (Physical Exam needs to be no more than 18 months old)
  • Please print and complete this form
  • The first section is to be completed by yourself and the second section to be completed and signed by a Healthcare provider
  • It can be returned by either delivering it to the health center directly, faxing to 914-251-6388, or scanning to the Health Services email, or uploading to the Patient Portal .
• Meningococcal Vaccination Response form
  • The Meningococcal vaccine is strongly recommended to reduce the risk of the potentially fatal meningococcal disease
  • For those under 18yrs old, then please print, complete, and return this form
  • For those older than 18yrs, there is a survey when you log into MyHeliotrope
• MMR Immunization Record
  • The New York State Public Health Law 2165 requires that any student living on campus regardless of matriculation status or credit load must submit proof of two immunizations for Measles and one each for Mumps and Rubella. 
  • Check out the official policy for more detailed information about the Purchase College Mandatory Immunization Requirements.
  • The Westchester County Department of Health provides MMR vaccinations at White Plains location vaccination clinic. You must call for an appointment, walk-ins are not accepted.
  • Please reach out to health services for any additional clarifications.