Health Records Forms

The medical forms linked below are required by the Health Center prior to entering Hiram College.

Pages 1 and 2 of the forms are to be filled out as complete as possible.  These records are necessary for us to have in order for us to accurately treat the student.

Pages 3 and 4 will need to be taken to your health care provider for completion of physical exam and immunization record.

Your private health care provider must do this.  The sports physical given to the athletes at the college is not acceptable for this record.

The insurance waiver is required yearly for all students.

The completed forms should be mailed to:

Hiram College Julia Church Health Center
P.O. Box 67
Hiram, OH  44234

or they may be faxed to us at 330-569-5398

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Monday-Friday 8:30 a.m.-5 p.m. (closed for lunch 12:30-1:30)

Appointments required to see NP or MD

Nurse-on-call available

Monday-Friday 5 p.m.-midnight
Saturday and Sunday 10 a.m.-10 p.m.
(while college in session)

Contact Us

We can be reached during regular office hours at 330-569-5418 (fax:  330-569-5398)