Important Forms
Please find a list of forms below that may be useful for you to become in compliance with your immunization and Health Record requirements at 51³Ô¹Ï.
Most commonly needed forms
- Meningitis Response and Information form (pdf)
- Release of Information (pdf)
- General Student Health Record (pdf)
- Healthcare Student Medical History & Physical Report (pdf)
- Tuberculosis Screening (pdf)
- Cardiac Athletic Questionnaire (pdf)
- Immunization Form (pdf)
- Under 18 Permission to Treat (pdf)
- Consent for Treatment/Privacy Policy (pdf)
There are a variety of ways you can submit your paper work.
- Upload your documents directly to your patient portal by clicking . Log in using your single on.
- Email to wellness@farmingdale.edu
- Drop off in person at the Health and Wellness Center. If the office is closed, you can deposit your forms in a secure mailbox located at the front and rear entrances of the Health and Wellness building.
- Fax: (934) 420-2137
- Mail: to 51³Ô¹Ï- Attn: Health and Wellness Center, 2350 Broadhollow Road, Farmingdale, NY 11735.
Insurance Related Information
- As of 2020, 51³Ô¹Ï is no longer offering a school sponsored insurance plan.
- Visit for information on New York State offered insurance plans.
Important Links
- Student Immunization Policy (pdf)
- Patient Rights and Responsibilities (pdf)
- Measles, mumps, and rubella Vaccine Information Sheet (pdf)
- Tetanus-diphtheria Vaccine Information Sheet (pdf)
- Menactra (meningococcal) Vaccine Information Sheet (pdf)
- Seasonal Influenza Vaccine Information Sheet (pdf)
- Tobacco Use Policy
Health & Wellness center
Hours
Monday | 9:00am - 4:00pm |
Tuesday | 9:00am - 4:00pm |
Wednesday | 9:00am - 4:00pm |
Thursday | 9:00am - 4:00pm |
Friday | 9:00am - 4:00pm |