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Instructions for Health History, Certificate of Immunization, and Tuberculosis Testing Results
Trinity School of Medicine requires that all students provide a health history, documented proof of immunity to certain contagious diseases, and results of a tuberculosis skin test prior to registration. A physician or other healthcare provider must sign the Certificate of Immunization and the Tuberculosis Test Results.
The Certificate of Immunization form contains the list of diseases for which documentation of immunity is required. Please note that dates of immunizations and titers with results are required.
DOWNLOAD IMMUNIZATION AND HEALTH HISTORY FORMS
The Certificate of Immunization form contains the list of diseases for which documentation of immunity is required. Please note that dates of immunizations and titers with results are required.
DOWNLOAD IMMUNIZATION AND HEALTH HISTORY FORMS
Health History - Required
Complete all sections and sign the appropriate statement in Section IV.
Certificate of Immunization - Required
Complete Part A and have your physician or other health care facility complete Part B. Any request for an exemption from immunization requirements must have signed documentation attached.
Tuberculosis Testing Results - Required
Complete Part A and have your physician or other health care facility conduct the test and complete Part B. Please note that a positive TST requires a follow-up chest x-ray, x-ray report, and information on prior treatment for tuberculosis.
Please mail or fax forms two weeks prior to registration to allow time for processing.
Mailing Address:
Student Health Forms
Trinity School of Medicine
Ratho Mill
P.O Box 1669
Kingstown, St. Vincent W.I.
FAX: (784) 456-9751
