New Student Health Information

All students are required to complete the Belmont Medical History form located under ‘Forms’ in the Health Portal.

Questions you will be asked include:

• Medication allergies
• Medical history
• Tuberculosis screening
• Emergency contact numbers

We use this information to provide the best care when you visit our clinic. This form will be submitted electronically for our review.

All students must enter the dates they received required immunizations in the health portal.  After entering the dates, there will be a prompt to upload immunization record(s). For your convenience, a printable immunization form for your physician to fill out can be accessed Here. Please note that if you utilize this form, the dates will still need to be entered electronically into your health portal along with uploading the document. 

We offer all required and some recommended immunizations in our clinic. Please visit the ‘Medical Services’ section of our website to review pricing.

• 2 MMR shots OR a positive blood test for immunity
• 2 Varicella shots OR proof of chickenpox disease as a child OR a positive blood test for immunity
• Meningitis ACYW booster AFTER the age of 16 if you are planning to live on campus (although it is strongly recommended for ALL students regardless of housing status)
• TB skin test within the past year if you answer ‘Yes’ to any TB screening questions on health form (if you cannot get a TB skin test due to previous positive results or sensitivity, we will accept a negative chest x-ray within 5 years or a negative Quantiferon gold test within the past year)

The following immunizations are not required, but strongly recommended:

• Updated COVID-19 vaccine
• 3 Hepatitis B vaccines
• Tetanus (Td or Tdap) vaccine within the past 10 years
• 2 Meningitis B vaccines
• 2 Hepatitis A vaccines
• Yearly influenza vaccine

The following immunizations are required for students planning to have patient contact for their program. (i.e. Nursing, Pharmacy, Medicine, OT, PT) *Please contact your program advisor for more detailed information:

• Positive blood test for immunity for Hepatitis B, MMR, & Varicella
• Tetanus (Tdap) vaccines within the past 10 years
• TB skin test within the past year (regardless of screening question answers)

Please visit the CDC for up-to-date information on current vaccines for adults (19 years or older).

Please review our ‘Student Consent for Treatment and Privacy Practices’ in its entirety and sign electronically through your health portal.

This document explains our services and your rights as a patient in our clinic. If you are under the age of 18, you must have a parent or guardian co-sign. We require this to be signed before your first visit to the clinic.

Click here to view the form

Click here to sign electronically

All students are required to upload proof of medical insurance through their health portal. See additional information on Fees and Insurance.