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 Forms. Please note the following instructions: 

Immunization History

Form should be printed and completed by your healthcare provider. All students are required to enter their immunization dates into the Patient Portal.  Then all forms will need to be uploaded to the Patient Portal. 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)

Physical Examination Form

Form should be printed and completed by your healthcare provider and uploaded into the Patient Portal.

• 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. Upload completed form into the Patient Portal.

• TB Risk Questionnaire  (.pdf)

Meningitis Vaccine Information and Waiver

Meningitis vaccine booster at > age sixteen. If you wish to waive the vaccine you will need to print, complete and upload the form into the Patient Portal.

• Meningitis Vaccine Waiver  (.pdf)

Insurance Information/ Insurance Cards

• Submitted via University Health Plans.    
• Upload 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, 2017, 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 may be uploaded via the Holy Cross Patient Portal or 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 be submitted to Health Services one week prior to your arrival on campus or by July 15th, whichever is earliest.

The Sports Medicine forms below are due one week prior to your arrival on campus or by July 15, whichever is earliest.

Incoming Student Athlete checkoff list (.pdf)

• 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)
• Orthopedic Health History Form (.pdf)
• Medical Consent and Shared Responsibility Form (.pdf)
• Holy Cross Concussion Policy (.pdf)  - Please read the document/consent form submit as applicable
• Student Athlete Authorization and Disclosure of Medical Information Form (.pdf)
• NCAA ADHD Drug Exception Policy (.pdf)- Please read over document and fill out page and send back to the Holy Cross Sports Medicine Department
• Insurance Policy Form (.pdf) - Please read the document/consent form submit as applicable

 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