Health Background Form

The University’s Health Background Form must be completed and submitted as soon as possible.

New York state law requires that all students provide proof of immunity against measles, mumps and rubella. It also requires that all students receive information about meningococcal disease and make an informed decision about whether to receive immunization against the disease.

The Jacobs School also requires that Hepatitis B titers demonstrate immunity.  

You cannot register for classes until you have fulfilled this requirement.

All incoming students must complete and return this health history and immunization form.

Submit the original, completed form to Health Services. Their website also includes information specifically for students in Health Related Professions.

University at Buffalo
4350 Maple Rd
Amherst, NY 14226

Phone: (716) 829-3316; Fax: (716) 829-2564