New Student Health Information

All students are required to complete the Belmont Medical History form located under ‘Forms’ in the Health Portal.

Questions you will be asked include:

• Medication allergies
• Medical history
• Tuberculosis screening
• Emergency contact numbers

We use this information to provide the best care when you visit our clinic. This form will be submitted electronically for our review.

All students must enter the dates they received required immunizations in the health portal.  After entering the dates, there will be a prompt to upload immunization record(s). For your convenience, a printable immunization form for your physician to fill out can be accessed Here. Please note that if you use this form, the dates will still need to be entered electronically into your health portal along with uploading the document. 

We offer all required and some recommended immunizations in our clinic. Please visit the ‘Our Services’ section of our website to review pricing.

• 2 MMR shots OR a positive blood test for immunity
• 2 Varicella shots OR proof of chickenpox disease as a child OR a positive blood test for immunity
• Meningitis ACYW booster AFTER the age of 16 if you are planning to live on campus (although it is strongly recommended for ALL students regardless of housing status)
• TB skin test or blood test (IGRA, QuantiFERON Gold, T-Spot) within the past year if you answer ‘Yes’ to any TB screening questions on health form *if you have had a previous positive TB test, upload the test result, a negative chest x-ray completed after the positive test, proof of treatment for Latent TB if applicable, and an Annual TB Symptom Screening within the past 12 months.

The following immunizations are not required, but strongly recommended:

• Updated COVID-19 vaccine
• 3 Hepatitis B vaccines
• Tetanus (Td or Tdap) vaccine within the past 10 years
• 2 Meningitis B vaccines
• 2 Hepatitis A vaccines
• Yearly influenza vaccine
• HPV

The following immunizations are required for students planning to have patient contact for their program. (i.e. Nursing, Pharmacy, Medicine, OT, PT) *Please contact your program advisor for more detailed information:

• 3 Hepatitis B vaccines 
• Tetanus (Tdap) vaccine within the past 10 years
• Positive blood tests for immunity for Hepatitis B, MMR, & Varicella required by some programs 
• TB skin test or blood test (IGRA, QuantiFERON Gold, T-Spot) within the past year, regardless of screening question answers. *If you have had a previous positive TB test, upload the test result, a negative chest x-ray completed after the positive test, proof of treatment for Latent TB if applicable, and an Annual TB Symptom Screening within the past 12 months. 

Please visit the CDC for up-to-date information on current vaccines for adults (19 years or older).

Please review our ‘Student Consent for Treatment and Privacy Practices’ in its entirety and sign electronically through your health portal.

This document explains our services and your rights as a patient in our clinic. If you are under the age of 18, you must have a parent or guardian co-sign. We require this to be signed before your first visit to the clinic.

Click here to view the form

Click here to sign electronically

All full-time, degree-seeking sstudents are required to provide proof of health insurance coverage or enroll in Belmont’s Student Health Insurance Plan (SHIP). More information can be found on the SHIP webpage. For questions or assistance with student insurance, contact studentinsurance@belmont.edu or 866-233-4512.