Student Health Services Forms

        

Immunization Record Form PDF: this form should be completed by your doctor and returned to the Health Center as soon as possible. Failure to submit this form will prohibit you from attending classes in accordance with New York State Law.

International Student Immunization Record PDF

Athletic Physical Form PDF: this should be completed by your doctor and returned to the Athletics office. Anyone who wishes to participate in an intercollegiate sport must have this form on file with the College.

Immunization Release Form PDF: this form allows the College to release your health records to you or your designee.

Medical History Form PDF: this form should be completed by the student to supply the Health Center with information regarding the student’s health history.

Meningococcal Meningitis Fact Sheet PDF: important information about Meningitis.

Online Meningitis Response Form : this form can be submitted by the student to notify the Health Center of the date of the Meningitis immunization or to decline the meningitis immunization by signing a waiver.

Participation Insurance Form PDF: this form should be completed by student athletes and their parents and submitted to the Athletics Office.

Contact:

Marsha A. Glose RN-C, BSN, MSEd.
Director of Health Services
Medaille College
18 Agassiz Circle
Buffalo, New York 14214
(716) 880-2112
FAX (716) 880-3399
E-mail: mglose@medaille.edu

I'm grateful for the education I've received.

The instructors were knowledgeable and welcomed class discussions, with
respect for each student's contribution. I've learned how to be a more
effective leader. My capstone class gave insight on how to combine all
the education learned to operate a business. That's when I realized how
much I had sharpened my knowledge.

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