INFORMATION FROM HEALTH SERVICES

First-Year students should begin working on submitting their Health Forms to our office. These are required by the state of Massachusetts and must be filled out by all full-time degree seeking students and part-time health majors. 

WHAT IS NEEDED:

• SELF-REPORTED INFORMATION: your current address, emergency contact information, allergies to medications and any serious medical issues. 

• CURRENT PHYSICAL: This needs to be from the last 15 months (June 2019).

• IMMUNIZATION RECORD: Your physician can complete the forms we provide or they can give you a school form which lists the information we are requesting.

• TUBERCULOSIS RISK QUESTIONNAIRE: Please complete all of the questions listed on that form. 

• COPY OF INSURANCE CARD: If you plan to purchase the schools plan with BCBS, you can provide that to us once you receive it.  

A copy of the Health Form is located at the bottom of this page. You can also access this information by visiting our website at www.worcester.edu/healthservices. 

Once you have completed the forms, there are three way to submit them:

• Mail forms to: Worcester State University Health Services 486 Chandler Street MA,  01602

• Fax forms to: 508-929-8075  

• Drop off forms in our secure mailbox: located right outside of our office. Health Services is located on upper campus in the Sheehan Building, to the right of the building. 

We understand that with the current climate that it may be challenging to get these required forms.  If your doctor’s office is not allowing people to come in to their office, you may have them fax the physical and immunization records directly to us and you can mail in your portion.  If you have any questions, please contact us at 508-929-8875 or email at avickstrom1@worcester.edu. 

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