Health Services

Health Forms

Undergraduate Students
Graduate Students

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. Please note that all forms are PDFs.

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 a 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 Physical Evaluation

Completed club sports form should be mailed to:

Director of Health Service
Clark University
950 Main Street
Worcester, MA 01610

Varsity athletics

If you are planning to participate in Varsity Athletics, please download and bring the athletic physical exam form to your medical appointment. The athletic physical examination form must be performed within 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

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 B.A. as part of the Accelerated Degree Program must submit a new TB Risk Questionnaire and a Meningococcal waiver. Immunization files will be reviewed by the Graduate School Office and students will be notified by e-mail if additional immunizations are needed.

All Graduate Students - 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. Please contact your graduate program/department if you have questions.

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 Services.

All incoming graduate students must complete and return the Graduate Immunization Record, TB Risk Questionnaire and Meningococcal Form to the following:

Please address envelopes as follows:

Graduate Admissions
Clark University
950 Main Street
Worcester, MA 01610 USA

Fax 508-798-4386 USA