Hiram College

Health Records Forms

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

Health Center Brochure

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 are required by law.

The completed forms are submitted online to the Julia Church Health Center. 

  • If you have any questions, please contact the Health Center Coordinator, Alison Johnston at: johnstona@hiram.edu

*You may take photos of your health insurance and/or prescription cards using your cell phone camera in order to upload. Please be sure to include front and back. 


Monday-Friday 8:30 a.m.-5 p.m. (closed for lunch 12:00-1:00 p.m.)

Contact Us

We can be reached during regular office hours at 330.569.5418