Immunization and Health History Form
All new students entering UW-Madison should complete an Immunization and Health History Form. The information you provide is confidential and will be retained by University Health Services (UHS) as part of your medical record. This information is valuable to students as they receive health care throughout their UW-Madison career.
In addition, students should use this form to comply with Wisconsin law [SS 36.25(46)], which requires students who live in a residence hall to report whether or not they have received vaccinations against meningococcal disease and hepatitis B. If you have been vaccinated, you must provide the dates of such vaccinations.
The Immunization and Health History Form is only available online. To get started, return to the University Health Services home page and click on MyUHS, our secure web portal.
You will need a Student ID Number and a Wiscmail account in order to log in. Remember to keep your username and password secure so that no one else can access your health information.
The ability to create your MyUHS account does not occur upon admission to the UW. Our health care software receives enrollment data from the UW-Madison Registrar/course enrollment system a semester in advance of your anticipated start date. For example, the earliest you can create your MyUHS account will be June if you are admitted for the Fall Semester. In addition to enrolling in classes, MyUHS account creation also requires a UW-Madison email address. All of this information typically becomes active in our system 24 hours after you attend your SOAR session. If you do not have plans to attend SOAR, we can arrange another alternative to activate your health care record. Please contact us by emailing us at MyUHS@uhs.wisc.edu.
Please note: Many students find it helpful to ask their parents for help filling out immunization dates and other health history information. However, access to a student’s health record should be limited to the student; parents and others may not access this information.
Tips for completing the form:
- There are four parts to the form: immunization history; health history; health insurance information; and patient contact information. You may complete and submit them in any order.
- You may wish to complete the form in a location with printer access, so you can print each page for your records as you finish it.
- We suggest that you skim through or print out each part quickly before you start entering data, to make sure you have gathered all the information necessary for completing that part of the form. If you close out of a part of the form before submitting it, you will have to re-enter that data. Here are example PDFs for you to look over and skim beforehand:
- Please do not use the “Enter” key while filling out the form due to limitations of the web application.
- Once you click Proceed to submit a part of the form, you will not be able to make changes in it.
