Student Requirements and Forms
Submitting Immunization Records to Student Health
The University of Iowa Student Health is partnering with Med+Proctor to capture MMR (measles, mumps, rubella) immunization records for most students.
All incoming students (freshmen, transfer, graduate, international) are required to submit records of (2) MMRs before or during their first semester. Go through MyUI to Create a Med+Proctor account and follow the instructions to upload your records.
All professional students starting a health science program (medical/PA, nursing, dental, EMT, speech pathology, physical therapy, radiation science, pharmacy) should not use Med+Proctor, but instead submit all records to firstname.lastname@example.org
Forms you may need
Please include your name and birth date (and/or university ID number) on ALL forms/documents mailed/faxed to Student Health. PDF format is preferred for emailed forms.
You need Adobe Acrobat to download the forms. Visit the Adobe Acrobat Reader website to get your free reader.
- Health Requirements for All UI Students (FOR YOUR REFERENCE)
- Psychiatric Medical History (not required- only for new psychiatric patients before first appointment)
- Release of Information Form and Important Instructions (not required- only needed if you want Student Health to release your protected health information)
- Consent to Obtain Information Form (not required- only needed if you want a healthcare provider to send Student Health your information)
- Class Excuse Policy (FOR YOUR REFERENCE)
Submit ONLY if you are requesting an exemption to the UI immunization requirement because of a medical condition or religious belief. Students age 18 and over must complete and sign their own religious exemption form, including having it notarized.
- Iowa Department of Public Health Medical Exemption form
- Iowa Department of Public Health Religious Exemption form
Health Science students
- Requirements for Health Science Students- These requirements are NOT for incoming first year (freshmen) students who want to eventually pursue a health science profession. They are needed before starting the first semester of Medical school, Nursing, Dental, Physical Therapy, Pharmacy, Physician Assistant, Radiation Science, EMT and Speech Pathology programs. They are not required for students in "pre-" or "interest" programs. You will have time to complete once you are officially accepted into those programs!
- OPTIONAL: Health Science Student Requirements Form - Use of the form is optional, but you might find it very helpful to make sure you complete all the requirements- use it as a checklist if not your records submission form. Other documentation such as official immunization records and or/medical records will be accepted. Titers and other lab tests require a copy of the lab results report to be sent.
- Two-Step TST Protocol
- TST Reading Policy
- Hepatitis B Titre Protocol
- Health Screen Form (REQUIRED)
- History of Positive TB Screening Results Form (only for those with history of positive TB screening result, if not completed at Student Health)
For medical students doing clerkships/rotations:
- AAMC Standardized Immunization Form Instructions (how to complete this form electronically, without a visit)
Minor students (under 18 years)
Health fee & insurance
- Insurance Form - Information we need to bill any Student Health charges to your insurance. (Can send in advance, or student will complete at first visit)
- Health Fee Form (only needed if taking 4 hours or less and want to come to Student Health without paying an office visit)
Allergy patient information
ADHD patient information
- ADHD Frequently Asked Questions (FAQs)
- ADHD Provider Letter and Transfer of Care form
- ADHD Checklist