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Geisel School of Medicine Student Requirements

Medical Record Requirements

  1. Each student must provide a health care provider completed Dartmouth Geisel Immunization Form, or a copy of your immunization record obtained from your home doctor, prior school, or military.
     
  2. Each student must provide a completed Tuberculosis Screening/Testing Form.
     
  3. Each student must complete a series of Online Health Forms accessed through the 'Health Services Forms' link on your Banner account.

Download the Geisel Checklist to make sure you've met all requirements.

Mail paper health forms to:

Dartmouth College Health Service
ATTN: Medical Records
7 Rope Ferry Road
Hanover, NH 03755. 

Please allow 7-21 days for your forms to be processed. Once your forms are processed you will receive an email, to your Dartmouth.edu email account, advising you if you are compliant or if there are outstanding requirements. 

Online Form Instructions

Complete the series of Online Health Forms accessed through your Banner page following the steps below:

  1. Enter your NetID and password (created in the "claim your account" process).
  2. Look for the 'Health Services Forms' link under 'Information Required Prior to Check-In'.
  3. Select the ‘Forms' tab from the 'Health Center Online' menu.
  4. Complete the following online forms:
    1. Authorization to Provide Medical Treatment- Your consent allows you to be seen and treated at the Health Service (Dick's House).
    2. Health History Form- Enter your medical history and family history details here.
    3. Acknowledgement of Complaint Process- You are acknowledging you have read and reviewed the Dick's House complaint process.
    4. Immunizations- Use your copy of the paper immunization form to enter dates of your vaccines. Your paper immunization form will not be processed at the Health Service until you have successfully completed the online immunization form.
    5. New Hampshire Patient Bill of Rights- You are acknowledging you have reviewed the NH Patient Bill of Rights.
    6. Notice of Privacy Practices- You are acknowledging you have reviewed the Privacy Practices.
    7. Fees and Eligibility Form- While most services at Dick's House are provided at no additional cost, this form acknowledges that you are aware that there are some visits/services that have an associated charge.

Do not complete the NCAA online form. This form applies to returning athletes only.

Important Information

  • Dartmouth does not require a physical exam. We ask that you provide us with your medical history, allergies, medications, family history, etc. when completing the online Health History Form accessed through Banner (see Checklist). Only if you intend on participating in a Varsity sport or Men’s Rugby, will the Athletic History and Physical Exam form ALSO be required.
     
  • If you are not in compliance with health and immunization requirements prior to the deadline you will have a health hold placed on your Banner account. A health hold will prevent you from electronically checking in for your first term.
     
  • If you do not have Dartmouth insurance, the health and immunization paperwork is STILL required. The health and immunization requirements are separate from the insurance portion of your requirements.
     
  • TB Screening Form: If you answer 'no' to all questions, in section A, you still must sign and submit form. If you say 'yes' to any questions, please refer to the TB Screening form for instructions. 
     
  • We require a hard copy of the immunization record to authenticate the information entered into the online form.
     
  • All forms must be officially translated to English.
     
  • If you have shared your password with someone for them to help you with form completion, please be aware that anyone who has your password will also have access to your confidential medical records and information.
     
  • If you have any questions about the immunization and health requirements please contact Jacqueline Carter in the Medical Records Office at (603) 646-9404.