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Please use this form to take to your doctor to complete. When completed you can enter and upload this form to comply with Dominican's immunization requirements at Wellness Center Online.  Login with your Dominican Credentials, go to Immunizations and enter your required immunizations. Then upload an image of your document under the Upload tab.

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Dominican University is committed to providing a healthy, safe environment for all students, and expects Dominican students to be active partners in maintaining a healthy and safe campus for the entire community. The Wellness Center is your partner in achieving this goal. 
All students  must submit their immunization records to Wellness Center online  A $75 fine will be applied to the student account each semester a student is not in compliance with immunization requirements.
Immunizations are now managed on a secure healthcare portal: Wellness Center Online. Login with your Dominican credentials.
Measles, Mumps, Rubella: (MMR) two vaccinations after first birthday
Meningitis: one vaccination after 16th birthday for students 22 years and younger. 
Tetanus, Diphtheria and Pertussis: (TDAP) within past 10 years
Students taking online classes: Students enrolled online are only exempted if they are enrolled in a program specifically designated by the University as an "Online Only" program. All other online study is not exempted from compliance requirements.  

Students born before January 1, 1957: Students born prior to this date are considered by the Illinois Department of Public Health to be immune to Measles, Mumps, and Rubella. However, they must submit to the Wellness Center proof of a TDAP immunization within the last 10 years and proof of their birth date. Meningitis is not required.
  • Failure to comply with immunization requirements will result in fines. 
  • The state can legally block your registration for classes if your immunization forms are not on file.  
You may not need to see your healthcare provider to complete your Immunization Certificate. You may enter and submit records from your prior schools or doctors, and upload records completed in prior years. Immunization records can be found at your prior school, at your doctor or medical provider.
If you need immunizations or blood tests to confirm immunity, these services are available for a low fee at the Wellness Center by appointment during the academic year.
Religious exemptions: If you have a religious exemption, you need to come to the Wellness Center to meet with a provider to complete the exemption, or pick up a form for your own doctor complete. 
Feel free to call or email the Wellness Center with any questions.
Phone: 708-524-6229