Get Quincy College Immunization Form

A. Login to your patient portal at myhealth.push.purdue.edu or on the PUSH website at purdue.edu/push. Once logged in, click the forms tab to locate the immunization information form.

Students may be required to complete a physical examination (see program-specific requirements. Additional immunizations may be required at certain clinical sites. Students assigned to those sites must complete additional requirements prior to starting that clinical rotation.

You do not need to bring your physical insurance card, only your plan information. You will not be billed for the vaccination. If you are receiving your second dose or booster dose, you must also bring your CDC card showing proof of having received the first dose(s) of the Pfizer vaccine.

Required Immunizations Two (2) doses of MMR (Measles, Mumps, and Rubella) received AFTER 1st birthday. TDAP or TD booster within the last ten (10) years. Meningococcal Conjugate (MCV4) on or after 16th birthday. Two (2) doses of Meningococcal B Series (if 25 years and younger)*

Students must provide proof of their immunizations and TB testing. The preferred and most efficient method to accomplish this is to download the Clinical Immunization form. This should be completed by the documenting physician's office and uploaded to the patient portal or faxed to 205-996-SHOT (7468) by the student.

Log into One. IU and go to Med+Proctor Immunization to submit your information. If you need immunizations from IUPUI Campus Health, call 317-274-8214 to make an appointment.

Please complete this form and return it to Queens College, Health Service Center, 6530 Kissena Blvd, Frese Hall 3rd Floor, Queens, N.Y. 11367 or email: healthquestions@qc.cuny.edu, or fax: 718-997-2765. Document must be legible to be processed.

Students may upload their official immunization record OR a completed immunization information form signed by an MD, DO, NP, or RN. The official immunization record does not need to be signed by a provider. If you are not able to access the portal immediately, please check back during the first week of classes.