Health Forms
Clark University Health Services
950 Main Street
Worcester, MA 01610
Telephone 508-793-7467
Fax 508-751-5947
Undergraduate Students
Please download, complete, and return your required health forms to the address below by July 1 for the fall semester and January 2 for the spring semester.
Director of Health Services
Clark University
950 Main Street
Worcester, MA 01610-1477
Tuberculosis_Screening_Questionnaire
Immunization Record
Meningitis info-waiver
Clark University Health Services PHYSICAL EXAMINATION FORM
Consent to Treat Minor
Please keep a copy of all of your forms for your records. If you choose to fax your forms, you must also bring a copy of your completed forms with you to Clark. Please do not email health forms to Health Services. Health Services will accept physical examinations within the past two years. Students should make arrangements for any needed immunizations with medical practitioners in their home country or state to avoid charges for immunizations and registration holds after arriving at Clark.
You will be notified via Clark email regarding the status of your health forms. You are responsible for checking your Clark email regarding your forms compliance. Please do not call the Health Service if you have not returned your forms by the deadline.
CLUB SPORTS: If you are planning to participate in Club Sports, please download and bring your pre-participation physical evaluation form below to your medical appointment.
Club Sports Pre-Participation Physcial Evaluation
Completed club sports form should be mailed to:
Director of Health Service
Clark University
950 Main Street
Worcester, MA 01610
VARSITY ATHLETES: If you are planning to participate in Varsity Athletics, please download and bring the Athletic Physcial exam form to your medical appointment. The Athletic physical examination form must be performed with six months of the start of the students initial athletic season stating clearance for sport activity and signed by a Doctor, Nurse Practitioner of Physician Assistant.
4 Page PPE Form
ADD-ADHDform
Signature Page
Completed Varsity Athletic forms should be mailed to:
Clark University Sports Medicine Office
950 Main Street
Worcester, MA 01610
Graduate Students
Graduate Immunization Record
Graduate Tuberculosis_Screening_Questionnaire
Graduate Meningitis info-waiver
Accelerated Degree Program Students - Undergraduates students who enter a master's degree program after earning their BA as part of the Accelerated Degree Program must submit their Immunization records to the Graduate School Office along with a TB Risk Questionnaire and a Meningococcal waiver. Student can contact Health Services to obtain the immunization records they submitted to Health Services upon entering Clark as undergraduates. Please submit the forms to Denise
Robertson in the Graduate School. Immunization files will be
reviewed by the Graduate School Office and students will be notified by e-mail if additional
immunizations are needed.
All incoming graduate students must complete and return the Graduate Immunization Record,
TB Risk Questionnaire and Meningococcal Form to the following:
GSOM Students in the following programs must return forms to Deanna Scaramangos, Graduate School of Management (GSOM)
- Master of Business Administration (MBA)
- Master of Science in Finance (MSF)
- Master of Accounting (MSA)
- MBA/CDP Dual Degree Program
- MBA/ES&P Dual Degree Program
IDCE Student in the following programs must return forms to Erika Paradis, International Development for Change & Environment (IDCE)
- Community Development & Planning (CDP)
- Environmental Science & Policy (ES&P)
- Geographic Information Science for Development & Environment (GISDE)
- International Development & Social Change (IDSC)
Student in all other programs must return forms to their departments or directly to Denise Robertson in the Graduate School.
Please address envelopes as follows:
Name (See above)
Department
Clark University
950 Main Street
Worcester, MA 01610 USA