Hiram College

Health Records Forms

The Health Center requires students to complete and submit the medical forms below prior to entering Hiram College.

Required forms

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, Nicole Coy at coyn1@hiram.edu
  • 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.


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

Contact Us

We can be reached during regular office hours at 330.569.5418