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Offices and Services / Health Services / Forms

Health Services

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Forms

These forms are downloadable PDFs—some can be completed by you, others require information from your healthcare provider.

Required Documents for New Students 

  • College Health History and Physical Examination
  • MMR Immunization Record
  • Meningitis Response Form (to be submitted to SHS for students under 18 years of age)

 

Medical Leave of Absence

For students with a mental health condition, please do not use these forms. Contact the Counseling Center at (914) 251-6390.

  • Medical Leave of Absence Handout Q&A
  • Medical Leave of Absence Procedure for Re-enrollment

Study Abroad Forms and Tips

  • Information Regarding Travel Meds
  • International Travel Clinics and Immunization Providers
  • SUNY Overseas Academic Programs
  • Targeted Testing for TB - RAQ
  • Travel Health History
  • Travel Tips

Make an Appointment for Travel Medicine Consultation for Travel Abroad

Health Services

  • Available Services
  • Forms
  • Request Medical and Immunization Records
  • HIV Testing
  • After Hours Medical Care
  • Mpox Information
  • Mandatory Immunization Requirements

Medicat Connect

Patient Portal Login

Contact Us

Our Location:
Campus Center South, Lower Level

  • Office: (914) 251-6380
  • Appointments: (914) 251-7925
  • Fax: (914) 251-6388
  • Weekdays after 5:00pm and on Weekends you can call FONEMED (the Nurse Advice Line) (844) 938-1024

hse@purchase.edu

Information for:

  • Current Students
  • Faculty and Staff
  • Parents and Families
  • Alumni
  • Lifelong Learners
  • Visiting Students

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Purchase College State University of New York
735 Anderson Hill Road
Purchase, NY 10577, USA
(914) 251-6000
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