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Welcome Geisel Class of 2022!    
** Health requirements are due by June 30, 2018! **

All enrolled students must meet State of New Hampshire, Dartmouth College, and Geisel School of Medicine health and immunization requirements.

Download the 'Geisel Student Checklist', here, to ensure you meet all requirements.

What is required of each student?

1. Each student must provide a health care provider completed Dartmouth immunization form (see PRINTABLE FORMS below), or a copy of your immunization record obtained from your home doctor, prior school, or military. If you obtain a copy of your immunization record from your home doctor, prior school, or military, please be certain your records include the REQUIRED vaccines indicated on the 'Checklist', above.

2. Each student must provide a completed Tuberculosis Screening and Tuberculosis Testing Form (see PRINTABLE FORMS below).


  1. Geisel Student Checklist (in case you missed it above)
  2. Immunization Form
  3. Tuberculosis (TB) Screening and Testing Form


Complete the series of online health forms accessed through your Banner page following the steps below: 

  • Go to: and enter your previously claimed NetID and password.
  • At the main Banner menu page select the Health Services link, 'Health Services Online‘
  • Select the ‘Forms' tab from the Health Services menu.
  • Complete the following online forms:
    • Authorization to Provide Medical Treatment- Your consent allows you to be seen and treated at the Health Service (Dick's House).
    • Health History Form- Enter your medical history and family history details here. This information becomes a part of your Dartmouth College medical record.
    • Acknowledgement of Complaint Process- You are acknowledging you have read and reviewed the Dick's House complaint process.
    • Immunizations- Use your copy of the paper immunization form to enter dates of your vaccines. Your paper immunization form will not be processed at the Health Service until you have successfully completed the online immunization form.
    • New Hampshire Patient Bill of Rights- You are acknowledging you have reviewed the NH Patient Bill of Rights.
    • Notice of Privacy Practices- You are acknowledging you have reviewed the Privacy Practices.
    • Dick's House Billing Acknowledgement (Fees & Eligibility)- While most Dick's House services are provided at no additional cost, this form acknowledges that you are aware that there are some visits/services that have an associated charge.
    • Do not complete the NCAA online form.

MAIL PAPER HEALTH FORMS TO: Dartmouth College Health Service, ATTN: Medical Records, 7 Rope Ferry Road, Hanover, NH 03755. Please allow 2-3 weeks for your forms to be processed. Once your forms are processed you will receive an email advising you if you are compliant or if there are outstanding requirements.



- If you are not in compliance with health and immunization requirements prior to the deadline you will have a health hold placed on your Banner account. A health hold will prevent you from electronically checking in for your first term.

- Even if you do not have Dartmouth insurance the health and immunization paperwork is required. The health and immunization requirements are separate from the insurance portion of your requirements.

- Even if you answer 'no' to all questions on the first page you must complete and return the form. If you say 'yes' to any questions, you will need to bring your form to a provider for review.

- We require a hard copy of the immunization record to authenticate the information entered into the online form.

- ALL forms must be officially translated to English.

 If you have any questions about the immunization and health requirements please contact Jacqueline Carter in the Medical Records Office at 603/646-9404.

Last Updated: 6/12/18