Student Health Form
Download the Student Health Form Here
Dear Student,
The Health Services staff would like to welcome you to Belmont. As part of your entry into the Belmont community, Belmont University requires that all students (full time, part-time, undergraduate, and graduate) submit a completed Belmont University Health Form.
You should receive the health form in your admissions packet. It is also available to download from our website (http://www.belmont.edu/healthservices). The health form must be sent directly to Belmont University Health Services prior to course registration.
The form itself is divided into four sections:
- Demographic information
- Health insurance information (please attach a copy of the front & back of your insurance card)
- Physical exam
- Immunization record
While we do not require the physical exam, we do recommend it. However, the vaccinations are mandatory. Make sure that your provider signs off at the bottom of the health form.
All immunization requirements are located on the health form. The requirements include proof of two Measles, Mumps and Rubella vaccinations for those born after 1956; a series of (3) doses of the Hepatitis B vaccine; the Meningococcal Meningitis vaccine for students who will be living on campus and a Tetanus injection within the past ten years. Students in the College of Health Sciences have additional requirements that are explained on the health form. All immunizations are offered through the clinic.
If childhood immunization records are not available, we accept proof of one MMR vaccination after 1989 or proof of immunity. Both the Hepatitis B vaccine and the Meningitis vaccine are strongly recommended but not required. If you choose not to have either of these vaccines, your signature is required declining these immunizations located on the second page of the health form.
The health form should be sent separately from all other admissions and registration forms. It has its own deadline and should be sent directly to Health Services. Students who have not submitted a completed Belmont University Health Form by the end of their first academic semester will be restricted from course registration for the subsequent semester until the form is on file in the clinic.
Please mail your completed health form to:
Belmont University
Attn: Health Services
1900 Belmont Blvd.
Nashville, TN 37212
We look forward to meeting each of you. If you have any questions,please do not hesitate to call (615) 460-5506.
Sincerely,
Katy Wilson
Director of Belmont Health Services
