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:

  • Health Record & Consent Form

  • Sickle Cell Form (only required of athletes)

    Immunization Information: All students must provide their immunization record on their completed health form. This policy is based on the recommendations of the American College Health Association (ACHA) and is designed to protect the health of all students. Hiram College requires that that entering students have been vaccinated against measles, mumps, rubella, tetanus, diphtheria, and pertussis polio. Hiram College recommends that all students are vaccinated against varicella, meningitis ACYW, meningitis B and hepatitis B. Entering students may also want to consider vaccination against Hepatitis A and HPV. 

    Students may seek an exemption from the vaccine requirement if they have a medical condition that prevents them from receiving any of the required vaccines or a sincerely held religious belief against receiving the vaccine. Please submit the exemptions form and paper work to the Julia Church Health Center.

    Meningococcal disease is a rare and potentially fatal bacterial infection. Hepatitis B is a serious viral liver infection with potential for long-term complications. Due to the revised code regarding Meningococcal and Hepatitis B vaccinations enacted by the General Assembly of the State of Ohio we are required to provide information from the Ohio Department of Health on meningococcal disease, Hepatitis B and college students. Please read the information carefully and submit your medical forms. The Health Center at Hiram College suggests that you discuss the facts about meningitis/hepatitis B with your health care provider.

  • Immunization Exemption Form

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 Administrative Assistant, Nicole Coy at: coyn1@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