Required Forms

1. College Entrance Health History and Physical Exam Form

(Physical Exam must  be no more than 18 months old.)

• Please print and complete the College Entrance Health History and Physical Exam form.
• The first section is to be completed by yourself and the second section to be completed and signed by a Healthcare provider.
• Submit by either delivering to the Health Center directly, faxing to 914-251-6388, scanning to the Health Services email, or uploading to the Patient Portal.

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2. Meningococcal Vaccination Response Form

The Meningococcal vaccine is strongly recommended to reduce the risk of the potentially fatal meningococcal disease.

• For those under 18 years old, please print, complete, and return the Meningococcal Vaccination Response form.
• For those 18 years and older, there is a survey when you log into MyHeliotrope.

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3. 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. 

Please fill out the MMR Immunization form.

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. 

• To schedule an appointment for vaccination, please email the Westchester County Department of Health and include the following information:
  • name of the vaccine
  • your name
  • date of birth
  • address
  • phone number
  • your status as a Purchase College, SUNY student

Please reach out to health services for any additional clarifications.