Health Certification

Dear Incoming Student:

The staff of the Hammond Health Center is pleased to welcome you to Ithaca College! Hammond Health Center provides comprehensive primary medical care services for all Ithaca College students. We are fully accredited by the Accreditation Association for Ambulatory Health Care.

Prior to beginning classes, we need you to complete health certification forms on-line AND to provide an official immunization record. This is required in order to comply with New York State law, as well as to protect your health and that of your fellow students, and to provide us with information that will help us to understand and serve your health needs while you are here at Ithaca College. All health care records at the Hammond Health Center are confidential and are completely separate from any other College records.

To access the system for submitting this information, go to the Hammond Health Center’s web page at The site will be available after May 1, 2018. Select the MyICHealthCenter tab from the menu bar on the bottom left side. You must complete your college Netpass activation prior to attempting to access this portal. You will be required to enter your Ithaca College Netpass user name and password followed by your birth date on the next page for added security purposes. Once you have successfully entered the portal, select “Forms” from the menu bar on the left and follow the instructions.

The following forms are REQUIRED to be completed on line at MyICHealthCenter:

    • Record of 2 MMR’s is required by New York State law for entrance into Ithaca College
    • Completion of this on-line form is required IN ADDITION TO the requirement that official documentation of your immunization history is sent to us as indicated below.

The following is REQUIRED to be submitted to us by mail or fax:

  • ENCLOSED IMMUNIZATION FORM SIGNED BY YOUR HEALTHCARE PROVIDER OR A PRINTED OFFICIAL RECORD OF YOUR IMMUNIZATION HISTORY. Only copies of official records such as school immunization records, or verification by a health care provider will be accepted.
  • MINOR CONSENT FORMS SIGNED BY A PARENT OR GUARDIAN (MANDATORY ONLY FOR ANY STUDENT WHO WILL BE LESS THAN 18 YEARS OLD UPON ARRIVAL AT ITHACA COLLEGE.) These forms may be printed from Forms Download page in the MyICHealthCenter web portal OR from the documents section of the Health Center’s web page.
  • In addition, please submit the enclosed PHYSICAL EXAM form or a record of a physical exam performed within the past year.
  • As per NCAA requirements, incoming intercollegiate athletes must also submit a record of sickle cell trait testing results and a pre-participation exam form that will be sent to you separately by the athletics department.

Please complete these requirements by June 15th for fall admission or one week before the beginning of classes for spring or summer admission. We will notify you via secure messaging to your Ithaca College email account if anything is incomplete. It is your responsibility to open and read all email messages sent from the Health Center. Failure to submit the requirements as outlined above will result in a hold being placed on your student account which will prevent you from receiving financial aid, adding, dropping, or registering for classes or receiving grades.

If you have questions, please contact Jenna Niedermaier, Administrative Assistant, at 607-274-1334 or e-mail We look forward to helping you with your healthcare needs and wish you all the best as you begin your academic studies at Ithaca College.


C. Vivian Lorenzo, M.D.

Physician and Medical Services Director

Hammond Health Center

Secure Web Portal
Remainder of Health Certification Form

Please remember to sign into My Ic Health Secure web portal using your netpass (email user name and password for your Ithaca College email) and complete the forms online. Thank you.