Health Records Forms

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

These forms should be as complete as possible. This information is necessary as it helps us to accurately treat students, and immunization records (starting on page two of the Health History Form) are required by law.

The completed forms can be:

  • *scanned and emailed to Health Center Coordinator, Tricia Fincham at: This email address is being protected from spambots. You need JavaScript enabled to view it.
  • printed and faxed to 330.569.5398
  • printed and mailed to:
                Hiram College Julia Church Health Center
                 P.O. Box 67
                 Hiram, Ohio 44234


*You may take photos of your forms using your cell phone camera in order to scan them in and email them, but please be sure to take photos of ALL pages.

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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)