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Completing & Submitting the Form

Where can I get a copy of the Student Medical Report Form?

The Student Medical Report Form, including an instruction sheet, is available as a PDF on the MIT Medical website. Download and print the file before filling it out. If you cannot access the file online for any reason, send us an email.

Who must complete the Student Medical Report Form?

All incoming students must complete the Student Medical Report Form, regardless of age or insurance status. This includes undergraduate students, graduate students, transfer students, remote students, and readmitted students, including military personnel, regardless of age. It also includes special students, visiting students, and exchange students.

I received my undergraduate degree from MIT; now I’m returning as a graduate student. Since I submitted the Medical Report Form when I entered MIT as a first-year undergraduate, do I need to submit the form again?

Yes. We need to make sure you are still up to date on necessary vaccines and tests. In addition, it’s possible that prematriculation requirements have changed since you submitted the form last time. For example, the Tdap (tetanus, diphtheria, and pertussis) vaccine is a relatively new requirement. Previously, we required only the Td (tetanus, diphtheria) vaccine.

But it might be easier to get your hands on your immunization record this time around. Since you were an MIT undergraduate, it’s part of the medical record we have for you. You can request it, and any other medical records you might need, from our Medical Records Service.

I have waived the Student Extended Insurance Plan. Do I still have to complete the Student Medical Report Form?

Yes. All entering students must complete the Student Medical Report Form, no matter which health insurance they have.

What if my medical records are not in English?

You must have the information on the Student Medical Report Form and all the required documents translated into English.

How should I return the form?

There are several ways you can return the form:
  • Fax: You may fax the form to 617-253-4121. Keep the original for your records. If the fax line is busy, please keep trying.
  • Mail: You may mail the form to MIT Medical – Health Screening, Room E23-127 77 Massachusetts Ave., Cambridge, MA 02139-4307
  • Email: Using a program that encrypts your personal health information is the safest way to transmit your form by email. Follow the steps below to send your form securely:
    1. Go to MIT Medical’s Secure Email Message Center
    2. If you already have a Zix Secure Email account, enter your email address and password to sign in. If you haven’t used Zix before, click on the “Register” button and follow the instructions to create and activate your account.
    3. Once you’re signed in, select compose and enter medrpt@med.mit.edu in the address field.
    4. Click on “attach file,” and follow the instructions to attach your medical report form.
    5. Click on “send” to transmit your form securely to MIT Medical. 

Will the MIT Student Medical Plan pay for my physical examination and required immunizations?

No. These are “prematriculation requirements.” That means they must be completed before you enter school at MIT. Your pre-entry physical examination, immunizations, or tests are not covered by the MIT Student Medical Plan or the MIT Student Extended Insurance Plan.