Required forms for new students – due June 15, 2022:
- New domestic students over 18 – create a MyChart account. Once created, complete the Health and Immunization Questionnaire online. If you are unable to acquire original documentation regarding your immunization record, please print and bring this form to your primary care physician for completion.
- New domestic students under 18 – print and bring this Health and Immunization Questionnaire to your primary care physician for completion. Email the completed form as an attachment to furmanstudenthealth@PrismaHealth.org.
- New international students – print and bring this Health and Immunization Questionnaire to your primary care physician for completion. Email the completed form as an attachment to furmanstudenthealth@PrismaHealth.org.
To expedite your appointment, please complete the New Patient Intake Form.
Students who have a particular medical contraindication or religious exemption to immunizations and vaccinations will need to complete the Immunization Exemption Request Form [PDF] in order to be compliant with the university’s immunization requirements. Please ensure that the form has the appropriate required signatures.
Students may give authorization for disclosure of medical information to a family member or other individual by completing the HIPAA Waiver [PDF].
Many current and former students may need immunization records. These individuals must complete the Authorization to Disclose Protected Health Information [PDF]. When completed, please email this form to firstname.lastname@example.org.