Health Records Forms

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

• Health History Form
• Physical Form
• Meningococcal and Hepatitis B Vaccination Form
• Sickle Cell Form (only required of athletes)

Pages 1 and 2 of the forms are to be filled out as complete as possible.  These records are necessary for us to have in order for us to accurately treat the student.

Pages 3 and 4 will need to be taken to your health care provider for completion of physical exam and immunization record.

Your private health care provider must do this.  The sports physical given to the athletes at the college is not acceptable for this record.

Along with these forms, please enclose a copy of your insurance and prescription cards.

The completed forms should be mailed to:

Hiram College Julia Church Health Center
P.O. Box 67
Hiram, OH  44234

or they may be faxed to us at 330-569-5398