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Accepted health records:

• Ë¿¹ÏÊÓƵ Immunization Form (stamped or signed by provider)
• Official Immunization record from a provider’s office (stamped or signed by provider)
• Official Immunization record from a State Registry

Please note: only dates in month, day, and year format (mm/dd/yyyy) will be accepted. Furthermore, if you have blood drawn (titers), lab results are required.

Submitting health records:

• Online:  (take a photo or scan and upload) 
• Fax: 716-839-8230
• Office: Health Services, Yurtchuk 116 (CHIP Center down the hall from Campus Safety) 

Health Services will NOT accept records submitted via email. 

• Ë¿¹ÏÊÓƵ Student Health Form- Amherst Campus
• Ë¿¹ÏÊÓƵ Meningitis Action Form- Amherst Campus
• Ë¿¹ÏÊÓƵ Student Health Form- Branch Campus
• Ë¿¹ÏÊÓƵ Meningitis Action Form - Branch Campus
• Ë¿¹ÏÊÓƵ Israel Study Abroad Immunization & Physical Form 

Please click here to visit the Clinical Student Health Requirements page. Please note: this webpage is for students completing the clinical experience portion of the following health science programs: Nursing, Physical Therapy, and Physician Assistant. 

In accordance with New York State Public Health Law (PHL) Section 2165, students are required to submit proof of immunity to Measles, Mumps, Rubella (MMR). As permitted by PHL 2165, medical exemptions are accepted by Ë¿¹ÏÊÓƵ.

If a student is seeking a medical exemption from the immunization requirement, proof must be submitted for approval from a licensed physician or nurse practitioner certifying that such immunization may be detrimental to the person’s health or is otherwise medically contraindicated.

Ë¿¹ÏÊÓƵ reserves the right to exclude students who submit a medical exemption for MMR vaccinations from living in on-campus housing. Exclusion also prohibits a student from visiting the residence halls on campus and living and/or visiting Ë¿¹ÏÊÓƵ subleased properties including, but not limited to, Collegiate Village and Snyder Park.

Exclusion under this policy does not relieve the student from any financial obligation to Ë¿¹ÏÊÓƵ.

Documentation can be submitted for verification by the CHIP Center:

• Online: or
• Fax: 716-839-8230
• Mail: 4380 Main St. Amherst, NY 14226 (PO Box 104)

• Vaccinations Offered: Hepatitis A &B, Japanese Encephalitis, MMR (Measles, Mumps & Rubella), Meningitis (MCV4), Rabies, Polio, Td/Tdap, Typhoid, Varicella (Chicken Pox), Yellow Fever. 
• Cost: $50 visit fee. Insurance is NOT accepted. Immunization costs must be paid out of pocket. Cash, check, and credit card accepted. Call for cost of individual vaccines.
• Address: 462 Grider Street, Suite 116 Buffalo, NY 14215
• Hours: Monday - Friday, 8:00 am- 4:00 pm. By appointment only. No walk-ins.
• Phone: 716-898-4153 

• Vaccinations Offered: Hepatitis A&B, Influenza, MMR (Measles, Mumps & Rubella), Meningitis, Polio, Pneumonia, Rabies, Tdap, Varicella (Chicken Pox), Shingles (Zoster), Yellow Fever, HPV, TB Skin Test, Japanese Encephalitis, Typhoid. 
• Cost: $25 visit fee. Insurance is NOT accepted. Immunization costs must be paid out of pocket. Cash, check, and credit card accepted. Call for cost of individual vaccines.
• Address: 2805 Wehrle Drive, Suite 2 Williamsville, NY 14221
• Hours: Monday - Thursday, 9:00 am- 5:00 pm. Some weekend hours are available. Call for specifics.
• Phone: 855-729-2479 

• Vaccinations Offered: Typhoid, Tdap, Hepatitis A & B, MMR (Measles, Mumps &Rubella), Meningitis, Polio, Varicella (Chicken Pox), Haemophilus,  Influenza B, Japanese Encephalitis, Shingles (Zoster), Rabies, Pneumococcal. 
• Cost: $40 visit fee. Insurance is NOT accepted. Immunization costs must be paid out of pocket. Cash, check, and credit card accepted. Call for cost of vaccines.
• Address: 100 College Parkway, Suite 260 Williamsville, NY 14221. 
• Hours: Monday-Friday 9:30 am- 2:00 pm. By appointment only. No walk-ins. 
• Phone: 716-631-0920

• Vaccinations Offered: Influenza, Pneumonia, Td/Tdap, Meningococcal (MCV4 & Men B.), Shingles (Zoster​)
• Cost: $20 visit fee. Insurance is NOT accepted. Immunization costs must be paid out of pocket. Call for specifics & cost of vaccines.
• Address: 608 William Street Buffalo, NY 14206. 8.8 miles from campus.
• Hours: Only available on the 2nd and 4th Friday of the month 8:30 am-11:30 am. By appointment only. No walk-ins.
• Contact: Phone- 716-858-7687 

Please note: this is not an exhaustive list of clinics in the area. The resources listed above are included due to the immunizations offered, cost and proximity to campus.

The Health Insurance Portability and Accountability Act (HIPAA) is designed to provide privacy standards to protect patients' medical records and other health information provided to healthcare professionals, hospitals, and parents or guardians of adults over the age of 18.

Complete the  to authorize the communication of medical information to persons designated. This authorization will become effective at signing and shall remain in effect as long as the individual is a student at Ë¿¹ÏÊÓƵ University. If the student wishes to revoke this authorization, the request can be submitted at any time by emailing health@daemen.edu. 

The Health and Insurance Services Office maintains your immunization records for 7 years after your date of admission to the University.

Complete the  to request a copy of your records. This information will only be used to identify your records and to send them wherever you designate.