Download the Form
All Student Health Forms must be submitted by:
August 1 (for Fall admits) or January 2 (for Spring admits)
Crouse Medical Practice
739 Irving Avenue
Suite 300, ESF Clinic
Syracuse NY 13210
FAX - 315-766-1614
ALL new first-year, transfer, graduate, and international students must submit the ESF Student Health Form, which gathers essential medical contact and immunization information.
Per New York State law, we are required to collect this information.
Pursuant to NYS Public Health Law § 2167, all students regardless of age, must read and certify that they have been informed about meningitis.
Any student who believes they should be exempt from the immunization requirements must submit the exemption request directly to Crouse Medical Practice before the thirtieth (30th) day of classes after enrollment.
Failure to submit the ESF Student Health Form by the identified deadline may result in a hold being placed on your account and having classes cancelled.