New student health requirements

Students will access most of their health requirements forms through their Medical Clearance list in myCornellHealth. Links to additional forms you may need are provided here. Visit Health Requirements for New Students for detailed instructions.

General forms

NCAA Student Athletes only

Using your legal name vs. chosen name on forms

If you use a chosen name that is different from your legal name, you may use either name on Cornell Health forms. Learn how to update your chosen name in myCornellHealth by visiting our Especially for LGBTQ+ Students page or our Especially for International Students page. 

Form submission instructions: 

  1. Download or print the applicable form below, and then complete all information. (Please use blue or black ink if completing a printed form.)
  2. Submit the form to Cornell Health in one of the following ways (unless otherwise specified on the form):
    • Upload the form through myCornellHealth (Cornell NetID required): go to Messages > New Message > Send message or attachment to Health Records
    • Fax it to 607-255-0269
    • Drop it off or mail it to:
      Cornell Health
      ATTN: Health Records Department
      110 Ho Plaza
      Ithaca , NY 14853-3101   

Release of health records; notice of privacy practices

Protected Health Information (PHI) patient rights forms

The Health Insurance Portability and Accountability Act (“HIPAA”) gives you the right to make the following requests regarding your Protected Health Information (PHI):

Health forms

Department charge authorization