Health Forms
Undergraduate Students (new incoming students only)
Students should make an appointment with their healthcare provider to complete the required health forms as soon as possible. Forms are due 12/18/24 for spring admission.
Please keep a copy of all of your forms for your records.
Upload health forms using Clark credentialsClark University Health Services
950 Main St.
Worcester, Mass. 01610
Telephone: 1-508–793–7467
Fax: 1-508–751–5947
Tuberculosis Risk Assessment
Please complete the top section of this form, sign and date it. If all answers are no, no further testing is required. If you answer YES to any of the questions, you are required to have your healthcare provider complete the bottom section of the form, sign and date it.
Download Screening FormPhysical Examination Form
Make an appointment with your health care provider to have your physical completed. We will accept physicals within the past two years.
Download Physical Exam FormUndergraduate Immunization
This form needs to be completed, signed and dated by your healthcare provider. You should try to complete as many of your required vaccines as you can prior to your arrival. There will be immunization clinics scheduled when you arrive at Clark University for those immunizations you may not have completed or that are not available in your country.
Download Immunization FormInformation about Meningococcal
Please complete the meningococcal form below only if you have not received the meningococcal vaccine which is required age 21 or younger.
Download informationPre-Registration Form
Complete with other health forms. This will be used for visits at health service.
Download pre-registration formGraduate Students (new incoming students only)
Students should make an appointment with their healthcare provider to complete the required health forms as soon as possible. Forms are due 12/12/24 for spring admission.
Please keep a copy of all of your forms for your records.
Upload health forms using Clark credentialsClark University Health Services
950 Main St.
Worcester, Mass. 01610
Telephone: 1-508–793–7467
Fax: 1-508–751–5947
Tuberculosis Risk Assessment
Please complete the top section of this form, sign and date it. If all answers are no, no further testing is required. If you answer YES to any of the questions, you are required to have your healthcare provider complete the bottom section of the form, sign and date it.
Download TB screening formGraduate Immunization Record
This form needs to be completed, signed and dated by your healthcare provider. You should try to complete as many of your required vaccines as you can prior to your arrival. There will be immunization clinics scheduled when you arrive at Clark University for those immunizations you may not have completed or that are not available in your country.
Download Grad Immunization FormInformation about Menigococcal
Complete only if age 21 years of age or under and did not receive meningococcal vaccine ACWY.
Download informationAccelerated Degree Program Students
Undergraduates students who enter a master’s degree program after earning their B.A. as part of Clark’s Accelerated Degree Program must submit a new TB Risk Questionnaire and a meningococcal waiver. Immunization records on file will be reviewed by the Health Services and students will be notified by email if additional immunizations are needed.
Upload health forms using Clark credentialsTuberculosis Risk Assessment
Please complete the top section of this form, sign and date it. If all answers are no, no further testing is required. If you answer YES to any of the questions, you are required to have your healthcare provider complete the bottom section of the form, sign and date it.
Download TB Screening FormMeningococcal Disease, Vaccine, and Waiver
This form must be completed if you are 21 years of age or younger and did not receive a meningitis vaccine at 16 years of age or older.
Download waiverHealth Services
501 Park Ave.
Worcester, MA 01610
1-508-793-7467
1-508-751-5947
Health Services is open Monday through Friday, 9 a.m. to 5 p.m.
Health Services is closed when the University is closed.
Directions:
Health Services can be reached either from Park Avenue or Birch Street. To get to Birch, take Maywood Street (heading toward Park Avenue) and then turn right onto Birch Street. Follow the signs to the Health Services building.