•	Medical Clinic
•	Women's Health
•	Sports Medicine
•	Self Care Cold & Wound Centers
•	Dispensary
•	Immunization & Allergy Clinic
•	Lab & X-Ray
•	Wart Clinic
•	Inpatient Services
•	Nutrition Clinic
•	Lewes Campus Services

•	Mission Statement
•	Location & Hours
•	Eligibility for Services
•	Fees
•	Immunization & Medical History Requirements
•	Health Insurance
•	Your Rights & Responsibilities
•	Student Health Advisory Council

IMMUNIZATION AND MEDICAL HISTORY FORMS

The forms listed below are to be used for printing out only. They will look compressed on your screen but will print out on a regular sheet of paper. These files are in pdf format. If you do not have software on your computer for viewing and printing pdf files the freely available Adobe Acrobat reader can be downloaded. Forms need to be faxed to (302) 831-6407 or mailed to:

University of Delaware
Student Health Service
Newark, Delaware 19716-8101

or faxed to (302) 831-6407.

Immunization Form

Medical History Form

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This website is not designed to respond to personal concerns nor emergencies. For emergency information, please call Student Health Services at 831-2226, or contact one of the facilities above.