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Student Health Form

Belmont University requires that all students submit a completed Belmont University Medical History Form, Immunization Record, and verification of health insurance  for undergraduates by the end of individual Foundations session prior to Welcome Week; for graduate students by the first day of orientation.


The confidential Health Form and Immunization Record is housed within Health Services’ secure portal. Please answer every question in the Medical History and submit. Complete the Immunization Record from your own vaccine records as accurately as possible.

Steps to completion:
1. Sign into MyBelmont (http://my.belmont.edu).
2. In the left-hand column, under the Personal Records heading is a link to Health Form.
3. Answer every question in the Medical History and submit it.
4. Complete the Immunization Record from your own vaccine records and submit it.
5. Submit a paper copy of your immunization records and a front/back copy of your
    insurance card to one of the below:
          •    Mail to Health Services, 1900 Belmont Boulevard, Nashville, TN 37212
          •    Email to healthservices@belmont.edu
          •    Fax to Health Services at 615-460-6131.

IMPORTANT: Health Form and Immunization Record must be completed and all documentation received to avoid a registration Hold.

The Online Health Form and Immunization Record is only available to deposited students.  Students’ Health Services account will be activated within 1 week of Admissions deposit.  Upon activation of the form, if a message says, “cannot authenticate log in”, please try again the following week.  Please notify Health Services if this occurs for more than one week.


Immunization records: Students will need their childhood immunization records to complete the Immunization Record.  If the student no longer has a copy of them, the records can be obtained from their primary provider, the health department, a high school, or previous university.

Current requirements for all students include:
     •  Tetanus or TDap booster within 10 years
     •  Two Measles, Mumps, & Rubella vaccinations for those born after 1956
         (or positive blood tests)
     •  Three doses of Hepatitis B (or positive blood test)
     •  Meningococcal vaccine for students living in the dorm
     •  Two doses of chickenpox vaccine, or a positive blood test, or provider documented date
         of the disease.
     •  TB skin test only if warranted (see the Health Form)

Current health insurance coverage
Please provide a copy of current health insurance coverage ( back and front of card) for confirmation.

Specialty Requirements for Health Science Programs
Students in College of Health Science programs may have additional requirements; please speak to your advisor for details.

Health Services does not bill insurance, but will accept cash or check, credit or debit for payment.   Immunization pricing available by telephone at 615-460-5506.


What are the requirements?
Each incoming degree-seeking student is required to:
     1.  Complete both a medical history form and an immunization form online.
     2. Submit to Health Services a paper documentation of immunizations from
          their medical provider
     3. Submit to Health Services a copy of current medical insurance.

What vaccines are required?
Tetanus vaccine within 10 years of matriculation
Polio vaccine, latest dose
Hepatitis B, series of 3
MMR(measles, mumps, rubella), 2 doses
Varicella(chickenpox)—either 2 doses of vaccine, documentation of disease from medical provider, or a blood test confirming immunity to varicella.
Meningitis-required of residential students only
TB skin test if warranted by” yes” answers on medical questionnaire.

If I am a health science student, are the requirements different?
Yes, health science students may need blood tests to prove immunity to Hepatitis B, MMR, varicella, plus a yearly TB skin test.

How can I find records?
Records can be retrieved from your pediatrician or family provider; from you high school or other college; from your local health department.

What if no records are available?
Then, make an appointment with Health Services to determine what must be done.

Where can I get the needed immunizations?
Health Services offers all these immunizations by appointment at a wholesale cost. Or, your family provider, clinic, the local health department.

Why do I have to get these immunizations?
Some are legal requirements of the State of Tennessee.  Others are merely good medical practice.

Why is meningitis vaccine recommended?
Even though bacterial meningitis is relatively rare, most cases occur in residential college students.  Bacterial meningitis infections have a very high fatality rate.

What is the deadline for me to submit the forms online?
All 3 required components must be complete no later than one month prior to matriculation.

How can I submit the required paper documentation of immunizations and the copy of my insurance card?
Paper documentation can be submitted in person, by mail, by fax, or by email.

What will happen if I do not complete all steps in this process?
You will be placed on a registration hold for the subsequent semester, which will only be removed once the requested process is complete.

I am unsure how to complete the online forms.  Where can I receive help?
The staff in Health Services is happy to answer questions in person, by email, or telephone.

What if I cannot access the online health form and immunization record?
In general, the data transfer from Banner to the Health Services electronic medical record does not take place until at least 2 weeks following deposit and issuance of your BUid. 
If you are a returning student, you may need a new BUid.  If you have married or changed your name, that change must be submitted via Belmont Central before the data exchange can take place.

I got married last year—who should I contact for a name change in the system?
Contact Belmont Central.

I will be attending a summer orientation session.  May I come to the clinic for immunizations during that time?
Absolutely.  Just call for an appointment.  Health Services staff is always happy to help.

I don’t have health insurance, can I still be seen in HS?
Yes.  Health Services does not charge insurance at all.  The information is kept on file in case of emergency.

Where can I find information to purchase health insurance?
On the Health Services website.

Does Belmont offer student health insurance?
Not currently.

Will my account be put on hold if I don’t have my insurance card?
No, only for missing medical history and immunization requirements.

My insurance coverage has changed.  Who should I contact to submit that change?
Health Services
McWhorter Hall Room 106
615-460-5506, office
615-460-6131, fax