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HEALTH FORMS (MANDATORY)

All forms must be returned to the Decker Student Health Services Center unless otherwise noted.

Certificate of Immunization

A record of 2 MMRs (or documentation of 2 Measles, 1 Mumps, and 1 Rubella) is required by New York State law for entrance into Binghamton University. There are two ways to send this information. 

  • Complete Certificate of Immunization found here. The form MUST be signed by a health care provider.

OR

  • Official documentation of your immunization history.

 Official Documentation: Documents including physician-verified history of disease, laboratory evidence of immunity (titers), personal records,
(i.e., baby book with official medical provider's signature or office stamp), or medical exemption. Other acceptable documents include a copy of
the immunization record from a prior school (high school or college), a migrant health record, a union health record, a community health plan
record, a signed immunization transfer card, a military dependent's "shot" record, the immunization portion of a passport, an immunization
record card signed by a physician, physician assistant or nurse practitioner, or an immunization registry record.

*You do not need to send both forms if required information is complete on one form*

Meningococcal Vaccination Response Form

Important information about meningitis from the New York State Department of Health can be found here

The following is acceptable to meet the Meningitis requirement:

  • A vaccine record indicating at least 1 dose of Meningococcal ACWY vaccine within the last 5 years or a complete 2- or 3-dose series of MenB.

OR

  • A signed response form indicating that the student will obtain Meningococcal vaccine within 30 days.

OR

  • A signed response form indicating that the student will not obtain immunization against Meningococcal disease.

*If the student has not received Meningococcal Vaccine within the past 5 years, they MUST submit the signed response form*

Students can find the Meningococcal Vaccination Response Form at: https://myhealth.binghamton.edu.

 You will need your Binghamton University Computer Account username and password to log into this site. 

Medical/Health History/Tuberculosis Questionnaire New students should complete this form found at https://myhealth.binghamton.edu prior to registration to provide information about their health and tuberculosis risk. You will need your PODS username and password to log into this site. See New Students for more information. COMPLETION OF THIS DOCUMENT IS A REQUIREMENT TO REGISTER FOR CLASSES AT BINGHAMTON UNIVERSITY. *The Tuberculosis requirement must be submitted PRIOR to registration for the NEXT semester. However, it is best for you to complete this requirement as soon as possible to avoid any holds for the NEXT semester.*

Under 18 Consent for Medical/Emergency Treatment : New students who are UNDER AGE 18 must have their parent/guardian complete this form to authorize Decker Student Health Services Center staff to provide medical or emergency treatment to the underage student. See New Students for more information. You will need your Binghamton University Computer Account username and password to log into this site.


 

OTHER FORMS

Authorization for Release of Protected Health Information (8k pdf): Use this form to authorize Decker Student Health Services Center staff to release certain health information about you to the party you specify on the release. This isn’t a “blanket” release form; it must specify the illness or injury we may release information about and to whom this information may be given. See Confidentiality for more information.

Health Insurance Waiver Instructions: New domestic undergraduate students should submit an online waiver if they wish to waive automatic enrollment in the University’s health insurance plan. See Health Insurance for more information. THIS WAIVER MUST BE SUBMITTED THROUGH BU BRAIN TO THE STUDENT ACCOUNTS OFFICE BEFORE THE 6TH WEEK OF CLASSES OR YOU’LL BE RESPONSIBLE FOR THE COST OF THE INSURANCE.

International Student Insurance Claim (132k pdf): International students who carry the State University of New York plan through Binghamton’s International Student and Scholar Services office should use this form to make a claim.

Phone: 607-777-2221
Fax: 607-777-2881

Regular Session Hours

Monday-Friday:
8:00 a.m.–4:45 p.m.

Walk-in care:
8:00–11:00 a.m.

Appointments:
1:00–4:00 p.m.

Blood work drawn: 
9:30–10:30 a.m.

Summer/Break Hours

Monday-Friday:
8:00 a.m.–3:45 p.m.

Walk-in care:
8:00–11:00 a.m.

Appointments:
1:00–2:45 p.m.

Last Updated: 6/27/18