Information on various forms to complete for Student Health Service.
All students must complete and return all forms prior to arrival on campus. Deadline for return is June 1 for students beginning study in the fall and January 1 for students beginning in January. All information disclosed will be kept confidential and will be shared only with appropriate University personnel on a need-to-know basis.
Forms can be emailed to email@example.com; faxed to 617.349.8225 or mailed to Lesley Student Health Service, 29 Everett Street, Cambridge, Ma 02138.
Student Health Service is available for Non-Resident Full-Time Undergraduate Commuters.
To sign up for this optional service you must complete and return the contract to Student Health Service before the third week of classes for each semester you wish to enroll. The $400.00 fee will be charged to your student account and is non-refundable.
NOTE: This service is NOT health insurance. Only non-resident full-time undergraduate students are eligible for this service.
A student can request their medical records be sent from or to SHS after completing the following consent forms for records release. Record requests are processed in the order received and generally require five to seven business days to complete. If you have additional questions regarding records, please contact firstname.lastname@example.org.
Health Service Center
Undergraduate Student Health Forms
After Hours Emergencies and Off-Campus Medical Options
Health Center Staff
Student Life and Academic Development
Contact and Location Info
Location: 11 Mellen St
Phone: 617.349.8534Fax: 617.349.8558
Graduate and Center for Adult Learner Student Immunization Form (.pdf)