Get Purdue Immunization Form

Completing the Purdue Immunization Form online is an essential step for students to ensure compliance with health requirements before attending Purdue University. This guide will walk you through each section of the form, providing clear instructions to facilitate the process.

Follow the steps to complete your immunization form online.

1. Press the ‘Get Form’ button to access the form and open it in your digital editor.
2. Begin by printing the form in English. Ensure all entries are filled out clearly, as the form requires visible signatures from both a medical provider and the student (or their parent/guardian if the student is under 19).
3. Fill in your last name, first name, middle name, Purdue identification number (PUID), date of birth in month/day/year format, contact number, and email address. Provide your emergency contact's name and phone number as well.
4. For section A, report your measles, mumps, and rubella (MMR) vaccinations. You must provide two doses administered after your first birthday, along with the dates in the format month/day/year.
5. Provide information about your Tetanus/Diphtheria booster, which must have been received within the last ten years. Indicate the date of the vaccination.
6. For section B, if you did not complete section A, list your two Measles doses taken after your first birthday.
7. In section C, report your TB test details, including the dates given and read, as well as the results in millimeters. Remember, this test must be completed in the United States.
8. If applicable, fill out the details for the Hepatitis B vaccine and Meningococcal vaccine, including the dates received or the titer results.
9. If you wish to refuse the Meningococcal vaccine, complete the waiver section and indicate the date of signing.
10. Complete the health history section by documenting past surgeries, significant family medical history, serious illnesses or injuries, chronic diseases, and any drug or food allergies.
11. For students under 18, a parent or legal guardian must complete the healthcare for minors section, authorizing medical care for the student, accompanied by signatures.
12. Once all fields are completed accurately, save your document. You may now download, print, or share the completed form as per the submission guidelines.

Complete your Purdue Immunization Form online today to ensure a smooth start to your university experience.