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Welcome Geisel School of Medicine Class of 2020!     ** Health requirements are due by June 30, 2016! **

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.
    • Dartmouth Hitchcock Agreement for Electronic Access- Your consent gives your health care provider at the Health Service access to your DHMC record for continuity of care.
    • 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.
    • 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.

Common Questions and Answers

Q: Do I need to have a physical exam prior to coming to Dartmouth?

A: No, the Health Service does not require a physical exam. We ask that you provide us with your medical history, allergies, medications, family history, etc. when completing the online Health History form.

Q: What happens if I don't complete the requirements prior to the deadline?

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

Q: Do I have to complete these requirements if I waived out of the Dartmouth Student Group Health Plan?

A: Yes! The health and immunization requirements are separate from the insurance portion of your requirements.

Q: I have most of my information ready to go but am missing proof of one of the required immunizations. Should I send in the information that I currently have or wait until everything is complete?

A: Please send us the information you currently have and follow-up with clinical documentation of any remaining vaccines.

Q: Do I have to complete the 'Tuberculosis Testing Form' even if I answered 'no' to all questions on the 'TB Screening Form'?

A: Yes! All incoming medical students must complete both the tuberculosis screening and testing forms.

Q:  Do I have to complete both the online immunization form AND submit the paper immunization form?

A: YES! We require a hard copy of the immunization record to authenticate the information entered into the online form.

 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: 6/16/16