Links and Contacts

Health Center Forms

We are committed to creating a safe and healthy college campus.  With that goal in mind, all new students are REQUIRED to submit the following medical documents prior to January 15, 2017.  Please complete and return the required health documents below to Family Medicine Associates at Endicott College located in Callahan Center Office 118 or fax to 978-998-8004.

Health Form (Day Division - Beverly)

The student fills out the “Student Information” section. • Your health care provider (physician or nurse practitioner) fills out the “Medical and Immunization History” and “Physical Examination” sections. Your physical examination must have been done within the last 12 months. Your health care provider may elect to submit this information on their own paperwork, as long as the information is on the practice’s letterhead or stamped with the medical practice’s information. 

Tuberculosis Risk Assessment • The “Tuberculosis Risk Assessment” is a two-sided form. (The student fills out side one, and if he or she answers “no” to all of the risk questions, there is no need to fill out side two.) If the answer to any of the questions is yes, the student’s health care provider must complete side two. 

If you misplace the forms, additional forms can be accessed on the Endicott College Health Center web page Resident students will not be permitted to move on campus until all health forms are received. If you have any questions or concerns, please contact Family Medicine Associates (FMA) at Endicott College at (978) 232-2104 or fma@endicott.edu.

Health Form (Van Loan School of Graduate and Professional Studies)

The student fills out the “Student Information” section. • Your health care provider (physician or nurse practitioner) fills out the “Medical and Immunization History” section. Your health care provider may elect to submit this information on their own paperwork, as long as the information is on the practice’s letterhead or stamped with the medical practice’s information. 

Tuberculosis Risk Assessment • The “Tuberculosis Risk Assessment” is a two-sided form. The student fills side one, and if he or she answers “no” to all of the risk questions, there is no need to fill out side two. If the answer to any of the questions is yes, the student’s health care provider must complete side two.

Information about Meningococcal Disease and Vaccination And Waiver for Students at Residential Schools and Colleges

 The form titled “Information about Meningococcal Disease and Vaccination and Waiver for Students at Residential Schools and Colleges” is a separate document from this Health Form. It explains that all resident students must have had the meningococcal vaccine within the past five years or must complete the waiver form. It is not a requirement for commuter students to receive the vaccine or to complete the waiver form. 

 

 


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