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Lasell University Health Forms

Health Services Staff welcomes you to the Lasell University. Below are links to the health forms which need to be submitted by the end of the first week of August for the Fall Semester; and the end of the first week of January for the Spring Semester. Please make an extra copy of the forms and bring them with you when arriving on campus. We also ask that you include a photocopy of the front and back of your insurance card and send this along with the health forms. Make an appointment with your health care provider as soon as possible to avoid delays in completing and forwarding your health forms. 

Please mail, email or fax health forms to:

Lasell University
ATTN: Health Services
1844 Commonwealth Avenue
Newton MA, 02466
Telephone: 617-243-2451
Fax: 617-243-2339

The Health Forms consists of five parts:

Personal Health History
This should be completed by you or with the help of a parent or guardian. It concerns basic information about your medical history.

Physical Exam
This needs to be completed by a health care provider.

Immunization Record
All of the vaccines listed on the top of the Immunization Record Form are required by Massachusetts State Law.

Tuberculosis Screening
Please complete the screening form and have signed by a health care provider.

Consent to Treat
This form must be submitted in order to receive care in Health Services. Parent must cosign if student is under age 18.

Please complete the additional Student Athletes Form.

Please note:
If you are considering a Study Abroad Program during your Lasell University career, please ask your health care provider to administer the Hepatitis A Vaccines.

It is important for you to know that each Health Form is held in confidence, and that no one has access to the health forms except Health Services personnel. All visits to Health Services (including treatments and discussions) are kept strictly confidential, except in the case of a medical emergency.

Health Services is closed during the summer months. If you have any questions or concerns regarding these health forms, please contact the Office of Students Affairs at 617-243-2124 in June and July. Health Services will reopen for administrative purposes only in August, and can be reached at 617-243-2451.

All Athletes’ health records will be shared with the Athletic Training staff.

For all Athletic Training students, please make an additional copy of all of your health records as you will need to present them to your advisor and your University internships.

Thank you,

The Health Services Staff at Lasell University