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Immunization & Health History Form

All new students entering UW–Madison must complete an Immunization and Health History Form. The information you provide is confidential and will be retained by UHS as part of a student’s medical record. This information is valuable to students as they receive health care throughout their UW–Madison career. The Immunization and Health History Form is only available online through a student’s MyUHS account.

Examples of the Immunization and Health History Forms


  1. Log in to MyUHS and select “Forms” in the left column. Complete all three forms. Enter the dates to the best of your ability. If you recall that you received a vaccine in the spring of 2005, then enter “3/1/2005”.
  2. Do not use the “Enter” key while filling out the form due to limitations of the web application.
  3. Once you click “Proceed” to submit a part of the form, you will not be able to make changes.
  4. Print a copy for your records before submitting each form.

If you have questions regarding the forms, email

To check your Wisconsin immunization record, visit the Wisconsin Immunization Registry.