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Student Health Forms

Domestic Undergraduates Full-time/Part-time

Required:

  • MMR: Two doses are required. First dose must have been received after first birth date. The second dose must have been received at least 30 days after the first dose. You must provide documentation of vaccination/titer (mumps/measles) or born prior to Dec. 31, 1956.
  • Meningitis: Required if living on campus and must provide documentation of vaccination after 16th birthday.
  • Health History: Including emergency contact, current and past medical history, surgical history and family history, and current medications and dosage. (Must complete online in the student portal.)
  • Tuberculosis Screening Questionnaire: This questionnaire is required of all domestic students who are enrolled at The University of Tampa. This form must be completed and signed by your medical provider. If the answer is YES to any of the questions, UT requires that a health care provider completes a TB screening with either a TB skin test by PPD Mantoux or blood test/ Lab (QFT or T-spot only). 

Domestic Graduates Full-time/Part-time

Required:

  • MMR: Two doses are required. First dose must have been received after first birth date. The second dose must have been received at least 30 days after the first dose. You must provide documentation of vaccination/titer (mumps/measles) or born prior to Dec. 31, 1956.
  • Meningitis: Required if living on campus and must provide documentation of vaccination after 16th birthday.
  • Health History: Including emergency contact, current and past medical history, surgical history and family history, and current medications and dosage. (Must complete online in the student portal.)
  • * Tuberculosis Screening Questionnaire: Must be completed and signed by your medical provider. If the  answer is YES to any of the questions, UT requires that a health care provider completes a TB screening with either a TB skin test by PPD Mantoux or blood test/ Lab (QFT or T-spot only).

International Students Full-time/Part-time Graduate/Undergraduate

  • MMR: Two doses are required. First dose must have been received after first birth date. The second dose must have been received at least 30 days after the first dose. You must provide documentation of vaccination/titer (mumps/measles) or born prior to Dec. 31, 1956.
  • Meningitis: Required if living on campus and must provide documentation of vaccination after 16th birthday.
  • Health History: Including emergency contact, current and past medical history, surgical history and family history, and current medications and dosage. (Must complete online in the student portal.)
  • All international students must complete one of the options below six months prior to semester begin date:
    • TB skin test by PPD or Blood test (QFT or T-Spot) is required within the last six months prior to semester begin date.
    • If PPD or blood test is positive, submit a physician signed copy of the chest X-ray report, not an image of the chest X-ray report.
    • Must be completed 3-6 months before arrival to campus.
    • If you arrive to campus without proper documentation, you will be referred to an infectious disease physician or passport health to have tuberculosis screening completed.
     


THIS WILL BE AT YOUR OWN EXPENSE! 
YOUR UNITED HEALTHCARE STUDENT RESOURCE INSURANCE WILL NOT COVER THIS TESTING. 

  1. Prior to attempting to login to the Student Health Portal, you must reset your password first at reset.ut.edu. Once your password is reset you can now login to the Student Health Portal (View Student Health Portal Instructions for more information) using your Spartan Domain (for example, John.Smith) username and password sent to you by the admissions office. If you are having problems logging into the Student Health Portal using your network (Spartan Domain) username and password, please contact the Student Helpdesk at (813) 253-6255 or studenthelp@ut.edu. If you did not receive a Spartan Domain username and password please contact Admissions at (813) 253-6211 or admissions@ut.edu 

  2. Click on Forms.
    Health Forms 1

  3. Under the Patient Portal section complete the online Health Center Medical History Form:
    Health Forms 2

  4. Under the Downloadable Forms section, download, print and complete the following forms:
    Health Forms 3
    1. Immunization Documentation (PDF)
    2. TB Screening Questionnaire (PDF)
    3. If applicable, Authorization to Treat a Minor (PDF), if under the age of 18
    4. Optional: Release of Information Consent (PDF). This form must be completed in person at the Health Center or signed by the student and notarized.
     
  5.  Click Upload. Scanned documents and/or phone images are accepted here.
    Health Forms 4

  6. Select the document or image you are uploading and upload as directed.

  7. Click Immunization and then Enter Dates link at the top of the page.
    Health Forms 5

  8. Enter immunization dates as documented on your immunization form that was uploaded.  

We do not accept health forms via email, fax or mail. All forms must be completed electronically using the student health portal. This is a requirement of The University of Tampa due to the high volume of incoming students. The immunization process consists of two-steps: 1) Uploading the immunization form, 2) Entering immunization dates. 

The immunization dates entered will automatically populate in the student’s electronic health record. The immunization form is used by the Health Center staff to efficiently verify these immunization dates entered. 

The Health Center will ONLY contact the student via phone or email regarding incomplete information. 

FREQUENTLY ASKED QUESTIONS:

Why complete these forms?

Completion of these forms is required for all students. These forms must be completed by the deadlines (July 1 for fall and Dec. 1 for spring). 

Who must complete the forms?

TB Screening Questionnaire: Must be completed and signed by a licensed physician, nurse practitioner or physician assistant.

Medical History Questionnaire: Completed by the student.

Student Immunization Form: Must be completed and signed by the student's health care provider or other signed documentation must be provided. Please be aware that failure to provide these records may prevent you from registering for classes. 

Authorization to Treat a Minor Form: Must be signed by a parent or legal guardian for any student under age 18 before receiving treatment at the health center.

Which vaccinations are required?

  • The State of Florida REQUIRES proof of two measles/mumps/rubella injections or results of a measles/mumps/rubella titers proving proper antibody levels.
  • The meningitis vaccine is REQUIRED for all students living in campus housing and cannot be waived. 
  • The Hepatitis B vaccine series is highly recommended. If you refuse to have the Hepatitis B vaccines, the student or a parent (if you are under age 18) must sign the Waiver of Liability section of the Immunization History form.

Who do I contact with additional questions?

If you have any questions about the student health center, these forms or the UT Online Student Health Portal, please call (813) 253-6250 or visit the Health and Wellness Center.

If you are having problems logging into the UT Online Student Health Portal with your network (Spartans Domain) user name and password sent to you by the Office of Admissions, please contact the Student Helpdesk at studenthelp@ut.edu or at (813) 253-6255

Spartans Domain uses the following format: first name.last name, for example "john.smith". Do not use "@spartans.ut.edu."