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.
Students cannot register for classes until they have fulfilled the immunization and meningitis information requirements listed on this form.
For the best experience use a non-mobile device.
- 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.
Please use one of the following methods to submit 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 | 716-829-2564 |
• Send your forms as soon as possible to facilitate class registration
• Do not return the forms to International Admissions
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 @buffalo.edu 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:
Please allow 10-15 business days for Student Health Services to process your records and update UB Learns.
Health and immunization records submitted to or generated by Student Health Services are held on file for 7 years from the date of submission.
Consent is required from students 18 years old and over, before Student Health Services can release any medical information to another person.
If other individuals or agencies have provided confidential information to Student Health Services, you cannot use the authorization form to re-release this information. For copies of medical records that came from another individual or agency, please contact that original individual or agency directly.
Student Life
University at Buffalo
4350 Maple Rd
Amherst, NY 14226
Phone: (716) 829-3316; Fax: (716) 829-2564
