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. Forms should be completed and uploaded by Monday August 12th, 2024, or 1 week prior to your arrival on campus, whichever comes earliest.

***PLEASE SEE OUR FREQUENTLY ASKED QUESTIONS PAGE FOR LOTS OF INFORMATION ON THE MOST COMMON QUESTIONS. ***

Health Services staff will review and verify all incoming students' records. Please note that it takes us time to get through all records, so do not be concerned if your record says "not verified." It is extremely helpful to us if you ensure your immunization dates are all typed in, otherwise, we have to enter them manually, which takes a significant amount of time for over 800 students. Thank you!

Immunization History

The Holy Cross form, or a form from your doctor's office must be uploaded to the portal. All students are required to enter their immunization dates and upload forms into 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)
• Medical/Religious Exemption Form (PDF)

Massachusetts residents will note their immunization history automatically uploads from the state immunization registry, and these students who received all their childhood immunization in the state of MA will not have to upload the immunization form or input any data.

For out of state students, please use the Verivax feature on the portal. Under the immunizations tab, click the YELLOW button stating "Request my Out of State Immunization Registry Records." Enter any addresses lived as a child, only address per state. Your state immunization registry will submit your records directly into the portal.

Students requesting an exemption for an immunization must complete the exemption form. A medical exemption must have documentation of the medically necessary exemption from a medical provider. If an outbreak of vaccine-preventable disease should occur, an exempt student will be excluded from class and/or the residence halls for a period of time.

Physical Examination Form

The form should be printed and completed by your healthcare provider and uploaded into the Patient Portal. Please note that you are NOT required to use the Holy Cross form, and may upload what your provider's office gives you, as long as it has the relevant information on it-- name, date of birth, allergies, current medications, and medical history.

Massachusetts Tuberculosis Risk Assessment

This form is located on the patient portal. Click on the form tab under the to do list. Click on Tb risk assessment form. Complete form and click submit. If you answer yes to any of the questions you should contact your healthcare provider. A tuberculin skin test or IGRA may be indicated.

• MA TB Risk Assessment
• MA TB Risk Assessment User Guide

Meningitis Vaccine Information and Waiver

Meningitis vaccine booster at age sixteen or older is required by the state of Massachusetts. If you wish to waive the vaccine you will need to print, complete and upload the form into the Patient Portal.

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 while living on campus, please print and have your parent/guardian complete the Authorization to Treat a Minor Form.

• Authorization to Treat a Minor Form (PDF)

How to Upload Required Forms

When the above forms are completed they may be uploaded via the Holy Cross Patient Portal. You must complete both steps of the upload process.

1. Under "Immunizations" enter dates of all immunizations received
2. Under "Upload" please upload required forms using the drop-down list

First Year Division 1 Varsity Student-Athletes

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

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

Health Services DOES NOT manage these forms, any questions can be directed to the Sports Medicine Department at (508) 793-2627.

Electronic Forms may be found within the "Forms" tab of your Patient Portal. In the event a form is not available, please download and complete the linked PDF form on this page, and upload it to your Patient Portal under the "Uploads" section.

Please view the provided checklist for further instructions and to ensure all necessary documents have been completed

• Pre-Participation Physical Evaluation: History Form - Upload completed form to your Patient Portal
• Orthopedic Health History Form - Upload completed from to your Patient Portal
• Student-Athlete Medical Billing Policy/Insurance Information Form - Upload completed form to your Patient Portal
• Medical Consent and Shared Responsibility/Assumption of Risk Form - Electronic form located within your Patient Portal
  • NOTE: If you will be under the age of 18 at the start of your athletic season, please use the link to download the form to allow parent/guardian consent and upload to Patient Portal with other forms
  • NOTE: The NCAA has mandated that all incoming Division 1 student-athletes submit proof of having been tested for Sickle Cell Trait. Lab results must be in to the Sports Medicine Department prior to participation in any intercollegiate activity.

  Upload Forms to Student-Athlete's Patient Portal - Patient Portal