Physical Exam Form

Physical Exam and Immunization form DUE July 31.
To complete the Medical Clearance Form follow these instructions: 

  • Download and print the
  • 2015 Physical Exam and Proof of Immunizations Form
  • Have a health care provider complete a physical and document it on this form.  The physical can be dated anytime after the start of your senior year of high school.    
  • Your immunization history is also documented by your health care provider on this form.  CT Law requires all matriculated college students to be vaccinated against: 
    • Measles, Mumps and Rubella (2 doses of each, all doses after age 1)
    • Neisseria Meningitis (a quadravalent dose after age 16)
    • Varicella (Chicken Pox) 2 doses, or physician documentation of disease or blood serology proving immunity.


To read information from the Centers for Disease Control (CDC) concerning recommendations for adolescent vaccinations, click here.


For students with documents from a country other than the United States this document may help with interpreting these shots in your own language.


Return the Medical Clearance form to: 
​​     Trinity College Health Center
     300 Summit St.
     Hartford, CT 06106

fax: 860-297-2020


Please contact us​ if you have any questions or if you need to request an extension of the July 31 due date.