Skip Navigation

Required Health Forms

All new students must submit required health forms, which include an immunization report, a physical form, and the TB Screening Questionnaire (or proof of negative TB Test within last 12 months, which can include PPD Skin Test, T-Spot Lab Test, or Quantiferon Gold Lab Test). Health forms can be submitted online, in person, or via confidential fax and are required before moving into residential halls and/or starting courses at Keene State College. Health forms are due on June 1, 2020 for fall 2020 enrollment. Failure to submit forms may prohibit students from moving into their residential halls until they are compliant.

Complete Your Health Forms Through the Patient Portal

Log in to the Patient Portal here! –> Patient Portal

All of the required health forms can be found on the Patient Portal, which is a secure electronic health record. If you don’t have access to a scanner, you can screenshot all the document pages and upload it onto the Patient Portal.

TIP: If you are graduating from high school this year, we encourage you to request a copy of your immunization record from your high school as soon as possible because many high school health offices are either closed or have limited hours in the summer.

Frequently Asked Questions

How do I submit my required health information?

Click on the link, Patient Portal , which will direct you to a Keene State College authentication page. Enter your KSC Net ID and password. After the system has verified you as a KSC student, you will be directed to the home page of the Patient Portal. If you have any questions, please contact us at #603-358-2450.

I missed the deadline, what should I do?

We will continue to accept health forms after the deadline, but know that students who are non-compliant may not be able to move into the residence halls or enroll in classes for the next semester until they become compliant. To avoid undue stress, please submit these forms as soon as possible. Fall Move-In Day will be here before you know it!

I am not living on campus, do I still have to submit health forms?

Yes, all new students are required to submit health forms. In the event of a communicable disease outbreak, students who are not adequately immunized or are without laboratory evidence of immunity may be excluded from school.

Do I need a new physical exam before coming to school?

No, we will accept a physical exam completed within two years of anticipated arrival on campus. Student athletes have different requirements. They should contact their athletic trainer or coach for specific requirements. Alternatively, Abe Osheyack, Assistant Athletic Director, can be contacted for further information:

Do I need to use your physical and immunization form?

No, we will accept any medical forms from your Pediatrician, PCP, or previous school medical office. We do require you to complete our TB Screening Questionnaire, which is located on the Patient Portal.

What are the required immunizations?

  1. MMR (measles, mumps & rubella): 2 doses required OR proof of immunity by blood titers.
  2. Varicella (chicken pox): 2 doses vaccine required or proof of immunity by blood titers. (History of disease confirmed by provider will be accepted. Self-reported history will not be accepted.)
  3. TDaP (tetanus, diphtheria & pertussis): Proof of TDaP on or after age 11 required and then tetanus booster if > or = 10 years since Tdap.
  4. Menactra (meningococcal ACWY): 2 doses required if 1st dose was done before age 16 or 1 dose required after age 16.
  5. MenB Series(meningococcal B): not required but is highly recommended.

I have a medical condition and immunizations are contraindicated, what should I do?

Please contact our office to speak to a nurse regarding a medical exemption waiver.

Who must be tested for tuberculosis?

Most students are low risk for Tuberculosis (TB) and will not require a test. This is determined by the answers you give to the questions in the TB Screening Questionnaire found on the Patient Portal. If you have a higher risk (indicated by your answers to questions on the form) you may need to be tested.

Do I have to purchase health insurance from Keene State?

No, Keene State does not require health insurance nor do we offer an insurance plan. We strongly encourage students to have health insurance because students may require referrals for x-rays, lab tests, and/or emergency care. These services are not covered by the KSC Student Health Fee. It is important for students to keep a copy of the insurance card with them while at school. Please refer to our Health Insurance 101 Brochure for more information. Students do not need to have health insurance to receive care at the Center for Health and Wellness.

The Wellness Center – Health Services

3rd Floor, Elliot Center
Phone: 603-358-2450, Emergency? Call 9-1-1
Fax: 603-358-2444

Regular Hours: M–F: 8:00a.m.-noon, 1:00-4:30 p.m.