Health Background Form

Provide information about your health history and immunizations.

If you did not yet read the informational immunization and meningitis requirements, please do that before completing and submitting this form.

Don't Miss Class Registration

Students cannot register for classes until they have fulfilled the immunization and meningitis information requirements listed on this form.

Download the Form

For the best experience use a non-mobile device.

Important Requirements

- This form requires the signature or stamp of your health care provider.

- Your health care provider must provide the requested information on this form. Students are not allowed to fill it out themselves.

-This form must be completed in English.

Submit Your Forms

Please use one of the following methods to submit your records:

Submitting Your Records
Upload  By Mail (USPS) By Fax
Upload your own
immunization records
to the Patient Portal.
Need help?
Student Health Services
4350 Maple Rd
Amherst, NY 14226
International Student Recommendations

• Send your forms as soon as possible to facilitate class registration

• Do not return the forms to International Admissions

Did UB Receive My Health Records?

New/Incoming Students

Once your immunization records have been received, processed, reviewed and deemed compliant with requirements, your health holds will be removed; this will be reflected in your HUB Student Center in real time. This usually occurs 5-10 business days after we receive your compliant records (although it can take a few extra business days during the 3 months prior to the start of a semester).

Students will not be individually contacted to confirm receipt of records. Please check the HUB system (NOT your Patient Portal) for the current status of your holds.

If your paperwork is not in compliance, you will receive an electronic message  from Student Health Services. This message is sent to the student’s email address.

Please contact us only if you have a hold on your account for a prolonged period of time after submitting your records/forms:

  • More than 10 business days (15 business days during high volume months of June, July & August) after faxing or emailing
  • More than 3 weeks after mailing

Returning Students in a Health-Related Program

Please allow 10-15 business days for Student Health Services to process your records and update UB Learns.

To Submit this Form, or Get Help

University at Buffalo
4350 Maple Rd
Amherst, NY 14226

Phone: (716) 829-3316; Fax: (716) 829-2564