Dear New Amherst Students and Families,
Welcome to Amherst College. As an Amherst student, you will be eligible to use the Health Center throughout the academic year. Please feel free to contact us or make an appointment to discuss any health concerns while you are at Amherst. We need to receive certain information from you in order to provide appropriate health care when necessary, to promote the goals of the College, and to comply with state law and regulations. Please refer to the checklist below in order to submit all of the necessary completed information. Forms are available for download on the Patient Portal. When completed the forms should be uploaded back to the portal. It is imperative that we receive completed forms by January 8, 2018. If your health file is not complete, you will not be able to register for courses when you arrive on campus!
Required Health Forms for All First Year or Transfer Students
1. New Student First Year Form 2017 (including Spring 2018 enrollments)
Forms must be completed by your medical provider. If immunization status is unknown or incomplete, obtain an antibody titer for measles, mumps, rubella, Hepatitis B, and varicella or arrange for re-immunization (as outlined on the attached Immunization Form). Massachusetts law requires up-to-date immunizations. These forms are only necessary once, when arriving for your first year.
2. Insurance Information
In addition to the immunization form, please send us a photocopy of both sides of your health insurance ID card and pharmacy benefit ID card (if you have waived the Amherst College Student Injury and Sickness Insurance Plan) by mail or fax 413-542-2647 (Click here for example). On July 11, 2017, the student insurance health forms, insurance waiver, and other materials will be available at the Gallagher insurance website. See Gallagher Student Insurance for more details.
Thank you for your assistance in meeting these college requirements. If you have any questions regarding these forms, please contact the Keefe Health Center’s Office at 413-542-2267 or firstname.lastname@example.org.
Dr. Emily Jones
Director of Student Health Services