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

All enrolled students of Dartmouth College must meet state of New Hampshire and Dartmouth College specific health requirements.

Download the 'Undergraduate 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.

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

3. Each student must complete a series of ONLINE health forms accessed through the 'Health Services Link' on your Banner account (see ONLINE FORMS TO COMPLETE below).

4. Any student considering participation in a Varsity sport or Men's Rugby should refer to the instructions on the Sports Medicine website regarding additional medical clearance requirements for athletic participation. All athletic clearance paperwork is due by July 1, 2018. Late submission may result in a delay to your sport participation.

5. Any student who will be under the age of 18 on September 1, 2018 must complete the 'Special Authorization for Minors' Form (see PRINTABLE FORMS below).


  1. Undergraduate Checklist (in case you missed it above)
  2. Immunization Form
  3. Tuberculosis (TB) Screening and Testing Form
  4. Special Authorization for Minors (for students who will be under age 18 on September 1, 2018, ONLY!)


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

    • Go to: and enter your NetID and password (created in the "claim your account" process).
    • Look for the 'Health Services Forms' link under 'Information Required Prior to Check-In'.
    • Select the ‘Forms' tab from the 'Health Center Online' 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.
      • 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 services at Dick's House 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. This form applies to returning athletes only.

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.


- 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. However, any student considering participation in a Varsity sport or Men's Rugby should refer to the instructions on the Sports Medicine website regarding additional medical clearance requirements for athletic participation.

- 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 shared your password with someone for them to help you with form completion, please be aware that ANYONE who has your password will also have access to your confidential medical records and information.

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