Hepatitis B - Meningitis Immunization Health History Form

The State of Tennessee mandates that The University of Memphis provide information concerning the Hepatitis B infection and Meningococcal disease to all students entering The University of Memphis for the first time.  The law does not require that you receive either immunization for enrollment.  Student Health Services urges our students to be immunized against Meningococcal Meningitis and Hepatitis B.

ALL new students must complete the Hepatitis B - Meningitis Immunization Health History Form before they can register.

This form is embedded in the registration process.  Please note that you must meet with your academic advisor before beginning the registration process.

If you are under the age of 18, a parent or legal guardian must sign your completed form.

Instructions for locating and completing the form:

1. Go to Spectrum Student Self Service and begin the registration process.
2. The form will display if the student is 18 years of age or older. The student must read the information provided, answer both questions, and then click on the Submit button. Once the questions are answered and submitted, the student will begin their course selection.
3. If the student is under the age of 18, a parent or legal guardian is required to sign the form and then return the completed form to Student Health Services. [Click here for a copy of the form]   Hint: Adobe Acrobat Reader is required to view and print the above form. [Click here to download a free copy of this software]  
   Completed forms may be mailed to: Student Health Services, 200 Hudson Health Center, Memphis , TN 38152 or faxed to (901) 678-3124 .

Note: A hold is automatically set to prevent a student's registration until the process is completed. Once completed, the hold automatically removes and the student is clear to register. There is no need to contact Health Services to remove the hold.

The Meningitis and Hepatitis B Vaccines are optional, if you choose to have the immunizations they are available at:

• The Memphis Shelby County Health Department - 901-544-7711
• Cost of the Hepatitis B Vaccine is $55.00 - per dose
• Cost of the New Meningitis Vaccine (Menactra) is $125.00
• The Shot Nurse Immunization & Wellness Service - 901-685-9999
• Cost of the Hepatitis B Vaccine is $65.00 - per dose
• Cost of the New Meningitis Vaccine (Menactra) is $120.00
• University of Memphis Student Health Services - 901-678-2287
• Cost of the Hepatitis B Vaccine is $58.00 - per dose

Many insurance plans cover the cost of the immunizations. Please contact your medical insurance carrier to determine if the immunizations are covered under your plan.

Student Health Services does not file insurance claims or forms.