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, 2016. 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.
The student fills out the demographic information (page 1). Please have your medical provider (physician or nurse practitioner) fill out the Medical History (page 2), Immunization Record (page 3), and Physical Examination (page 4). Your medical provider may elect to submit this information on their own paperwork as long as it is on letterhead or stamped with the medical practice’s information.
Information about Meningococcal Disease and Vaccination And Waiver for Students at Residential Schools and Colleges
All Resident students need to have the Meningococcal Vaccine within the past 5 years or complete this waiver form.
TB Risk Assessment
The student fills out page 1. If you answer no to all of the risk questions, you do not need to fill out page 2. If you do answer yes to any of the questions, please have your medical provider complete page 2.