Health Records Forms
The Health Center requires students to complete and submit the medical forms below prior to entering Hiram College.
- Health History Form
- Meningococcal Vaccination Form
- Sickle Cell Form (only required of athletes)
- Insurance Waiver
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:
- printed and faxed to 330.569.5398
- printed and mailed to:
*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.
Monday-Friday 8:30 a.m.-5 p.m. (closed for lunch 12:30-1:30 p.m.)
Appointments required to see NP or MD
Available 24/7 at 877.233.5159
We can be reached during regular office hours at 330.569.5418