University at Buffalo - The State University of New York
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Health Background Form

  • New York State law requires that all students provide proof of immunity against measles, mumps, and rubella. 
  • It also requires that all students receive information about meningococcal disease and make an informed decision about whether to receive immunization against the disease. 

You will cannot be registered for classes until you have fulfilled this requirement.

 Form Submission

Submit the original, completed form to:

UB Student Health Center
Student Health Services
Michael Hall
3435 Main Street
Buffalo, NY 14214

QUESTIONS ABOUT IMMUNIZATION FORMS?

Please contact the UB Student Health Services Office

E-mail, Confidentiality, and On-Line Medical Advice

If time is of particular concern for you, you should consider calling our office at 716-829-3316.

Email general questions now.

Email immunization questions now.