Important Forms
Below please find a list of forms that may be useful to you in being in compliance with your immunization and Health Record requirements at Farmingdale State College.
Most commonly needed forms
- General Student Health Record (pdf)
- Healthcare Student Medical History & Physical Report (pdf)
- Tuberculosis Screening (pdf)
- Athletic Medical Clearance (click here)
- Cardiac Athletic Questionnaire (pdf)
- Immunization Form (pdf)
- Meningitis Response and Information form (pdf)
- Consent for Treatment/Privacy Policy (pdf)
- Patient Rights and Responsibilities (pdf)
- Student Immunization Policy (pdf)
- Under 18 Permission to Treat (pdf)
There are a variety of ways you can submit your paper work.
- Mail: to Farmingdale State College- Attn: Health and Wellness Center
- Fax: 1-934-420-2137
- Email to wellness@farmingdale.edu
- Drop off in person at the Health and Wellness Center. If the office is closed you can deposit your forms in a secure mailbox located at the front and rear entrances of the Health and Wellness building
Insurance Related Information
- As of 2020, Farmingdale State College is no longer offering a school sponsored insurance plan.
- Visit https://nystateofhealth.ny.gov/ for information on New York State offered insurance plans.
Important Links
- Release of Information (pdf)
- Measles, mumps, and rubella Vaccine Information Sheet (pdf)
- Tetanus-diphtheria Vaccine Information Sheet (pdf)
- Menactra (meningococcal) Vaccine Information Sheet (pdf)
- Gardasil (HPV) Vaccine Information Sheet (pdf)
- Seasonal Influenza Vaccine Information Sheet (pdf)
- Tobacco Use Policy
Health & Wellness center
Hours
Monday | 9:00am - 4:00pm |
Tuesday | 9:00am - 4:00pm |
Wednesday | 9:00am - 4:00pm |
Thursday | 9:00am - 4:00pm |
Friday | 9:00am - 4:00pm |