Dear New Amherst Students and Families,
Welcome to Amherst College. As an Amherst student, you will be eligible to use the Health Center. 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. You can log into the patient portal using your Amherst College credentials, once your Amherst credentials are set-up. When completed, the forms should be uploaded back to the portal. If you do not have your credentials set-up yet, but need the forms, you can print them from the New Student First Year Form 2019 link below. You can also submit the forms via email, fax or mail. It is imperative that we receive completed forms by January 10, 2020. If your health file is not complete, your course registration will be placed on hold.
Required Health Forms for All First Year or Transfer Students
- New Student First Year Form 2019
Forms must be signed or stamped by your medical provider. Massachusetts law requires up-to-date immunizations as outlined in the forms. These forms are only necessary once, when arriving for your first year.
- Insurance Information
July 15, 2019 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.) If you have waived the Amherst College student insurance plan, please log on to the Patient Portal and enter your insurance information in the 'Insurance' tab of the portal. There, you can upload a photocopy of both sides of your health insurance ID card and pharmacy benefit ID card. (Click here for example). NOTE: Please upload the insurance information that you will be using when you are on campus. Please do note upload insurance that you won't be using.
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
Keefe Health Center
PO Box 5000
95 College Street
Amherst MA 01002
Phone (413) 542-2267
Fax (413) 542-2647