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

Incoming Division 1 Varsity Student-Athletes

Required Sports Medicine forms for all incoming varsity student-athletes must be completed prior to any athletic participation

Due: July 15 or 1 week prior to your arrival - whichever comes earliest

Incoming Student-Athlete Checklist

• Pre-Participation Physical Evaluation History Form
• Orthopedic Health History Form
• Insurance Policy & Policy Holder Information Form - Please be sure to provide a copy of the student-athlete's insurance card
• Medical Consent and Shared Responsibility Form
• Holy Cross Concussion Policy - Please read the document and return only applicable forms
• Student Athlete Authorization and Disclosure of Medical Information Form
• NCAA ADHD Drug Exception Policy Form - Please submit appropriate supporting documentation if applicable
• Sickle Cell Trait Explanation and Consent Form - The NCAA has mandated that all incoming Division 1 student-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.

Mail Completed Forms to:

College of the Holy Cross
Sports Medicine Department
One College Street
Worcester, MA 01610

Any questions can be directed to the Sports Medicine Department at (508) 793-2627