Meal Plan Medical Release Form

If your medical circumstances have changed, you may request to be released from your dining contract by completing a meal plan medical release form.

Meal Plan Medical Release Form

If you have a medical diagnosis: ask the medical provider who made the diagnosis to complete the Health Care Provider section on the release form.

If you do not have a medical diagnosis: make an appointment with a health care provider or contact Health Services at 508.999.8982 to request an examination.

Send your completed form to:

Fax: 508.999.8985

Mail: UMass Dartmouth Health Services
Attn: Director of Student Health Services
285 Old Westport Road
Dartmouth, MA 02747

QuickLinks

x

+