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
- Health Record (pdf)
- Mental Health Referral Letter (pdf)
- Athletic Physical Exam and Clearance (pdf)
- Cardiac Athletic Questionnaire (pdf)
- Immunization Form (pdf)
- Meningitis Response and Information form (pdf)
- Patient Rights and Responsibilities (pdf)
- Student Immunization Policy (pdf)
- Student Insurance Waiver (pdf)
- Student Voluntary Enrollment Form Accident and Sickness insurance (pdf)
Important Links
- Student Insurance Plan Overview
- Consent for Treatment/Privacy Policy (pdf, 18kb)
- 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
- Tobacco Use Policy
There are a variety of ways you can submit your paper work.
- Mail: to Farmingdale State College- Attn: Health and Wellness Center
- Fax: 1-631-420-2137
- Email: 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