Medical Forms

Required Medical Forms For All New Incoming Students

Holy Cross Health Services requires all new incoming students to submit the Holy Cross Medical Record Form. Please note the following instructions: 

Immunization History

Form should be printed and completed by your healthcare provider. The immunization dates can then be submitted via Online Student Health. This form will need to be mailed back to Health Services. The Health Services staff will verify that the immunization data correlates with the data that was submitted online.  For more information, please see Massachusetts regulations regarding immunizations.

• Immunization History Form  (.pdf)
• Instructions for Online Student Health - Immunization History

Physical Examination Form

Form should be printed and completed by your healthcare provider and mailed back to Health Services.

• Physical Form  (.pdf)

TB Risk Questionnaire

This form should be printed and completed by student. It should be reviewed with your healthcare provider. A tuberculin skin test is only required if you are considered high risk. A chest x-ray is needed if you have a positive skin test.

• TB Risk Questionnaire  (.pdf)

Meningitis Vaccine Information and Waiver

If you have not received the meningitis vaccine and wish to waive the vaccine you will need to print, complete and return this form.

• Meningitis Vaccine Waiver  (.pdf)

Insurance Information/ Insurance Cards

• Submitted via Online Student Health.        
• Mail a photocopy of the front and back of your medical/prescription insurance cards for our records.  Have your student carry his/her insurance cards on them when they come to college.

Minors

If you will not be 18 years old by August 28, 2013, please print and have your parent/guardian complete the Authorization to Treat a Minor Form.

• Authorization to Treat a Minor Form  (.pdf)

When the above forms are completed they should be mailed to(one week prior to your arrival on campus or by August 20th, whichever is earliest.):

College of the Holy Cross
Health Services
One College Street
Worcester, MA
01610-2395 

Important information for incoming Division 1 varsity athletes

The Sports Medicine Department asks that all forms above (Immunization History, Physical Exam Form, TB Risk Questionnaire, Meningitis Vaccine Waiver, Insurance Information/ Insurance Card, and Authorization to Treat a Minor Form) be submitted to Health Services one week prior to your arrival on campus or by July 15th, whichever is earliest.

All forms below (Sickle Cell Trait Letter, Pre-Participation Physical Evaluation History Form, Medical Consent, Holy Cross Concussion Policy, Student Athlete Authorization and Disclosure Form, and NCAA ADHD Drug Exception Policy) be submitted to Sports Medicine one week prior to your arrival on campus or by July 15th, whichever is earliest. 

• The NCAA has mandated that all incoming Division 1 athletes submit proof of having been tested for Sickle Cell Trait.  You must mail a copy of the current lab results or the lab results dating from birth to the Sports Medicine Department.  Lab results must be in to the Sports Medicine Department prior to participation in any intercollegiate activity.
• Sickle Cell Trait Explanation and Consent Form (.pdf)
• Pre-Participation Physical Evaluation History Form (.pdf)
• Medical Consent and Shared Responsibility Form (.pdf)
• Holy Cross Concussion Policy (.pdf)  - Please read the document/consent form and sign it on page 6 before returning to sports medicine.
• Student Athlete Authorization and Disclosure of Medical Information Form (.pdf)
• NCAA ADHD Drug Exception Policy (.pdf)  - Please read over entire document and fill out page 1 and send back to the Holy Cross Sports Medicine Department

 When the athletic forms are completed they should be mailed to:

College of the Holy Cross
Sports Medicine Department
One College Street
Worcester, MA
01610-2395