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Forms

Some information regarding your health is required for attending SUNY Potsdam. The following forms may be needed in certain circumstances. Please see "Health Requirements for Attending" for details on when it is necessary to submit them.

  • Proof of Immunization Form
    This form may be used to prove immunity to measles, mumps, and rubella instead of submitting a signed copy of your immunization record.
  • Tuberculosis Testing Form
    This form is to be submitted ONLY if you are told to do so after completing the online Tuberculosis Screening Questionnaire.
  • Meningitis Response Form
    This form must be submitted in paper form if the student is under 18 years old.
  • Meningitis Fact Sheet
    Information you can use to decide whether or not to be vaccinated against meningococcal meningitis.

Other Forms

  • Request for Religious Exemption from Immunization Requirement Form
    Call (315) 267-2377 and ask to speak with the registered nurse. She will send the form to you.
  • Immunization Exemption Form
    This form is NOT for Religious Waivers (see above). This form is for physicians to document a medical contraindication to vaccination.
  • Request for Release from Mandatory Health Fee
    (This is not the waiver for the SUNY Potsdam Insurance Plan. See the Health Insurance page for instructions on how to submit a waiver)
  • Release of Protected Health Information Form
    Use this form to request Student Health Services to send your records to another physician, or to send records to us.
     

Athletics Form

  • Athletic Questionnaire - After you make your appointment either online or by calling, please complete this questionnaire on the Student Health Services portal. Look on the home page under "To Do List." If you don't see it on your To Do List, then print the form here, fill it out, and bring it to your appointment.