Student Health & Counseling Forms
Before arriving on campus, ALL new students must send their completed Student Health Report, including immunization records and proof of covid vaccines (including booster, if eligible), to: [email protected] or fax 518-564-2188, or by mail to Student Health and Counseling Center, 101 Broad St., Plattsburgh, N.Y. 12901
Student Health Record
Instructions: Please download, read, complete and return to the health center as soon as possible.
Alphabetical List of All Forms
Acknowledgment of Receipt of Notice of Privacy Practices Form
Authorization for Use or Disclosure of Protected Health Information Form
Consent for Treatment, Payment, and Health Care Operation Form
Informed Consent for TeleCounseling and TelePsychiatry
International Student Health Record
Meningococcal Disease Fact Sheet
Instructions: New York State Public Law states that all students enrolled in 6 or more credit hours complete this form for their medical records. Please read the Meningococcal Disease Sheet and then complete the Meningitis Response form. You can mail, fax or email the printed form to the center.
A module that enables secure messaging between students and medical providers. Providers can send messages. attach medical reports and answer questions the student might have regarding the results. Students can request prescription refills and download and print their immunization records and new students can submit required medical information. To access the portal you need your SUNY Plattsburgh NetID and password.