University of Connecticut STUDENT HEALTH HISTORY FORM 2025

1. Click ‘Get Form’ to open the University of Connecticut STUDENT HEALTH HISTORY FORM in the editor.
2. Begin by filling in your personal information, including your last name, first name, middle name, pronouns, sex assigned at birth, date of birth, gender identity, net ID, and preferred name. Ensure all details are accurate for proper identification.
3. Proceed to the Immunization History section. For each required vaccination (MMR, Varicella, Meningococcal), select the appropriate option and enter the dates of your vaccinations. If you have titer results instead of vaccinations, fill those in as well.
4. Complete the Clearance to Play Club Sports section if applicable. Enter the date of your last physical exam and ensure your healthcare provider initials this section.
5. For NCAA student-athletes, provide proof of Sickle Cell Trait Testing status and ensure a healthcare practitioner signs off on the form.
6. Finally, review all entries for accuracy before submitting. Use our platform’s features to save and upload your completed form directly to the Student Health Portal by the submission deadlines.

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