Undergraduate Student Requirements

Your first interaction with Health Services will be the health requirements that you must meet as an incoming student which will begin our partnership in caring for your health while you are at Brown. Please be sure to take a few minutes to explore the Health Services and Counseling & Psychological Services websites for information about our services and BWell Health Promotion.

The deadline for submission is July 1, 2017. (January 2nd, 2018 for mid year transfers)

Please review and complete the required information listed. All forms can be accessed through the links below.  For continuity of care, we request that students forward their medical records for any chronic, serious medical condition.

If you haven't done so already, activate your Brown account. You will need your Banner identification number in order to activate your electronic services. This number was assigned to you when you applied for admission to Brown. If you need additional assistance, please contact the Computing Accounts and Passwords Office at 401-863-4357.

To return forms, the student must login to Brown Health Services Patient Portal and upload the forms.  
If you are unable to upload, fax the forms to 401-863-7953 or mail to: 

Brown University
Health Services
Box 1928
Providence, RI 02912

If you have any questions about your medical forms, please refer to Frequently Asked Questions before contacting us.

Steps 1, 2, 3, 4 and 5 are required for all students.
Steps 6 and 7 only if indicated.

Step 1: Brown Immunization Record (required)
We will also accept official immunization records from your provider, previous school or health department.

In order to attend Brown University, all students must comply with the State of Rhode Island immunization requirements. If you are missing any of the required immunizations, you will be contacted by Nursing@Brown.edu.

  • print and forward the form to your medical provider for completion
  • when you receive the completed form, log into Brown Health Services Patient Portal
  • select Immunization, Enter Dates
  • enter the dates as documented on your Immunization Record
  • then, select Upload
  • from the pull down menu, select Immunization Record
  • attach a copy of your form and upload

Step 2: Tuberculosis (TB) Screening Questionnaire (required)
All students must answer the first 7 questions. Depending upon the answers, some students may be required to have screening for tuberculosis.

  • print and complete the form
    - If a test is not required, sign the form.
    - If a test is required have your provider complete the TB test, document the result on the form.
    - If a test is required and you reside outside of the United States, please answer the 7 questions, sign the bottom. We do not accept testing performed outside of the United States. You will be contacted by Nursing@brown.edu to schedule an appointment for tuberculosis testing.
  • log into Brown Health Services Patient Portal
  • select Upload
  • from the pull down menu, select TB Screening Form
  • attach a copy of your form and upload

Step 3: Health History Form (required)
This information provides our staff with an overview of your health status and past medical history, allows us to provide you with the best care possible and to meet your health care needs. All medical information is strictly confidential, and cannot be released to anyone (including your parents, professors) without your authorization.

This form must be completed by the student only. It does not need to be completed nor reviewed by your medical provider.

Step 4: Authorization for Medical Care and Treatment form (required)

Step 5: Medical Insurance Card and Prescription Benefits Card
(required for all students that do not have the Brown sponsored insurance plan)

  • log into Brown Health Services Patient Portal
  • select Upload
  • from the pull down menu, select Medical Insurance Card or Prescription Benefit Card, if applicable
  • upload a copy of both sides of your card

If your insurance changes in the future, please upload a copy of your new card or bring the card to Health Services so we can update your information.

Step 6: Sports Physical Form (if applicable)
This form is required if you intend to participate in intercollegiate athletics (including Crew, Equestrian and Fencing). In compliance with NCAA regulations, we cannot clear a student to practice or participate in any team sport without a completed history and physical on file.
Completion is recommended even if students do not anticipate participation in intercollegiate athletics.

  • print and complete page 1 of the form
  • your medical provider must complete page 2 of the form
  • log into Brown Health Services Patient Portal
  • select Upload
  • from the pull down menu, select Sports Physical Form
  • attach a copy of your form (pages 1 and 2) and upload

A Sickle Cell screening test is required. We also will accept hemoglobin electrophoresis.

Step 7: Authorization to Treat a Minor Form (if applicable)
If you will not be 18 years old by August 15, 2017, your parent/guardian must complete the Authorization to Treat a Minor form.