ClarkYOU LOGIN | SEARCH

Welcome New Students More
Clark University health care services

HEALTH FORMS

Please download, complete, and return your required health forms by July 1, to:

NOTICE:
HEALTH INSURANCE WAIVER FORM
Complete this form if you have other, comparable coverage and want to remove the $1,829 insurance charge from your student bill.

All eligible fall students must complete a waiver (available from 5/29/2015) form by the deadline of July 20, 2015, for the 2015-2016 policy year.

Fall 2015 students who do not complete a health insurance waiver/enrollment form by the deadline, will be automatically enrolled in and charged for the Clark University Student Health Insurance Plan in order for the University to be in compliance with Massachusetts Law.

Director of Health Services
Clark University
950 Main Street
Worcester MA 01610-1477

PDF Forms

  1. Please keep a copy of all of your forms for your records.
  2. If you 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 get 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 Health Services if you have not returned your forms by the deadline.

Health Forms for Athletics

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 [PDF]

The 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 student's initial athletic season stating clearance for sport activity and signed by a Doctor, Nurse Practitioner, or Physician Assistant.

Varsity Athletics Pre-Participation Physical Evaluation [PDF]
ADD-ADHD Form [PDF]

The completed Varsity Athletic forms should be mailed to:

Clark University Sports Medicine Office
950 Main Street
Worcester MA 01610

Questions?

Visit Clark University Health Services or call us at 508-793-7467.