All new students enrolling at Keene State College are required to complete a Comprehensive Student Health Report, a Physical Form, an Immunization Form and a TB screening form. Failure to submit these four forms to the Center for Health and Wellness could result in a hold on your registration.

Health Forms

The Comprehensive Student Health Form, Immunization Form, Physical Form and Tuberculosis screen must be completed by every new student. The Comprehensive Student Health Form is in a writable PDF format which will allow you to type directly on the form.

1. Complete the Comprehensive Student Health Report [PDF] , print it and mail it to the address on the form.
2. Print the Physical Examination Form, Immunization Form and Tuberculosis Screening Form from the links below. Fill in your personal demographic information and forward these forms to your Primary Care Provider (PCP) to complete. Your PCP may return these directly to us but it is your responsibility to ensure that happens. You may use your most recent physical to complete the physical form.

• Physical Examination Form
• Immunization Form 2012
• TUBERCULOSIS Screen 2012
• Help downloading Adobe® Portable Document Format (PDF)

Mail completed forms to:

Health and Wellness
Keene State College
229 Main Street
Keene, NH 03435-2802

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