ÂÜÀòÉç

Accepted health records:

• ÂÜÀòÉçÌýImmunization FormÌý(stamped or signed by provider)
• Official Immunization record from a provider’s officeÌý(stamped or signed by provider)
• Official Immunization record from a State Registry

Please note: only dates in month, day, and year format (mm/dd/yyyy) will be accepted. Furthermore, if you have blood drawn (titers), lab results are required.

Submitting health records:

• Online: Ìý(take a photo or scan and upload)Ìý
• Fax: 716-839-8230
• Office:ÌýHealth Services, Yurtchuk 116 (CHIP Center down the hall from Campus Safety)Ìý

Health Services will NOT accept records submitted via email.Ìý

• ÂÜÀòÉç Student Health Form- Amherst Campus
• ÂÜÀòÉç Meningitis Action Form- Amherst Campus
• ÂÜÀòÉç Student HealthÌýForm- Branch Campus
• ÂÜÀòÉç Meningitis Action FormÌý- Branch Campus
• ÂÜÀòÉçÌýIsrael Study Abroad Immunization & PhysicalÌýFormÌý

Please click here to visit the Clinical Student Health Requirements page. Please note: this webpage is for students completingÌýthe clinical experience portion of the following health science programs: Nursing, Physical Therapy, and Physician Assistant.Ìý

In accordance with New York State Public Health Law (PHL) Section 2165, students are required to submit proof of immunity to Measles, Mumps,ÌýRubella (MMR).ÌýAs permitted by PHL 2165, medical exemptions are accepted by ÂÜÀòÉç.

If a student is seeking a medical exemption from the immunization requirement, proof must be submitted for approval from a licensed physician or nurse practitioner certifying that such immunization may be detrimental to the person’s health or is otherwise medically contraindicated.

ÂÜÀòÉç reserves the right to exclude students who submit a medical exemption for MMR vaccinations from living in on-campus housing. Exclusion also prohibits a student from visiting the residence halls on campus and living and/or visiting ÂÜÀòÉç subleased properties including, but not limited to, Collegiate Village and Snyder Park.

Exclusion under this policy does not relieve the student from any financial obligation to ÂÜÀòÉç.

Documentation can be submitted for verification by the CHIP Center:

• Online: or
• Fax: 716-839-8230
• Mail: 4380 Main St. Amherst, NY 14226 (PO Box 104)

• Vaccinations Offered:ÌýHepatitis A &B, Japanese Encephalitis, MMR (Measles, Mumps & Rubella), Meningitis (MCV4), Rabies, Polio, Td/Tdap, Typhoid, Varicella (Chicken Pox), Yellow Fever.Ìý
• Cost:Ìý$50Ìývisit fee. Insurance is NOT accepted. Immunization costs must be paid out of pocket.ÌýCash, check, and credit card accepted. Call for cost of individual vaccines.
• Address:Ìý462 Grider Street, Suite 116 Buffalo, NY 14215
• Hours:ÌýMonday - Friday, 8:00 am- 4:00 pm. By appointment only. No walk-ins.
• Phone: 716-898-4153Ìý

• Vaccinations Offered: Hepatitis A&B, Influenza, MMR (Measles, Mumps & Rubella), Meningitis, Polio, Pneumonia, Rabies, Tdap, Varicella (Chicken Pox), Shingles (Zoster), Yellow Fever, HPV, TB Skin Test, Japanese Encephalitis, Typhoid.Ìý
• Cost: $25 visit fee. Insurance is NOT accepted. Immunization costs must be paid out of pocket. Cash, check, and credit card accepted. Call for cost of individualÌývaccines.
• Address: 2805 Wehrle Drive, Suite 2 Williamsville, NY 14221
• Hours:ÌýMonday - Thursday, 9:00 am- 5:00 pm.ÌýSome weekend hours are available. Call for specifics.
• ±Ê³ó´Ç²Ô±ð:Ìý855-729-2479Ìý

Ìý

• Vaccinations Offered: Typhoid, Tdap, Hepatitis A & B, MMRÌý(Measles, Mumps &Rubella), Meningitis, Polio, Varicella (Chicken Pox), Haemophilus,Ìý Influenza B, Japanese Encephalitis, Shingles (Zoster), Rabies, Pneumococcal.Ìý
• Cost: $40 visit fee.ÌýInsurance is NOT accepted. Immunization costs must be paid out of pocket. Cash, check, and credit card accepted. Call for cost of vaccines.
• Address: 100 College Parkway,ÌýSuite 260 Williamsville,ÌýNY 14221.Ìý
• Hours:ÌýMonday-Friday 9:30 am- 2:00 pm. By appointment only. No walk-ins.Ìý
• Phone: 716-631-0920

• Vaccinations Offered:ÌýInfluenza, Pneumonia, Td/Tdap, Meningococcal (MCV4 & Men B.), Shingles (Zoster​)
• Cost: $20 visit fee. Insurance isÌýNOT accepted.ÌýImmunization costs must beÌýpaid out ofÌýpocket. Call for specifics & cost of vaccines.
• Address:Ìý608 WilliamÌýStreet Buffalo,ÌýNY 14206. 8.8 milesÌýfrom campus.
• Hours:ÌýOnly available on the 2nd and 4th FridayÌýof the month 8:30 am-11:30 am. By appointment only. No walk-ins.
• Contact: Phone- 716-858-7687Ìý

Please note: this is not an exhaustive list of clinics in the area. The resources listed above are included due to the immunizations offered, cost andÌýproximity to campus.

The Health Insurance Portability and Accountability Act (HIPAA) isÌýdesigned to provide privacy standardsÌýto protect patients' medical records and other health information provided to healthcare professionals, hospitals, and parents or guardiansÌýof adults over the age of 18.

Complete the Ìýto authorize the communication of medical information to persons designated.ÌýThis authorization will become effective at signing and shall remain in effect as long as the individual is aÌýstudent atÌýÂÜÀòÉçÌýUniversity. If theÌýstudent wishes to revoke this authorization, theÌýrequest can be submitted at any time by emailing health@daemen.edu.Ìý

The Health and Insurance Services Office maintains your immunization records for 7 yearsÌýafter your date of admission to the University.

Complete theÌýÌýto request a copy of your records. This information will only be used to identify your records and to send them wherever you designate.