Services: Forms
College Entry Forms (All Freshmen)
The Confidential Health Record 
must be submitted by July 21, 2012. Students under 18 may need assistance/information from their parents when completing the form.
Physical Examination Form 
Used to assure that immunizations are current and that entering students pose no public health problems; additionally provides a means of identifying students with special health care needs.
Minor Only Form (Any student under age 18)
Consent to Treat a Minor
Pennsylvania Law requires consent of parent/guardian for medical care of minors; if your dependent child is enrolled at Haverford College prior to his/her 18th birthday and you want his/her healthcare provided by Haverford College Health Services, you must first complete and return the consent form.
All Active Students - Deadline August 1
Health Insurance Enrollment/Waiver
All students are required to have health insurance. Active students must enroll in or waive insurance each year by August 1.
Other Forms You May Need
Records Release Form
If you wish to have a copy of your medical information shared with someone else, you will need to authorize Health Services to release your record. Visit Services: Confidentiality for more information >
Travel Health Form
Should be printed, filled out, and brought to your appointment when receiving immunizations for travel. Visit Services: Travel Health for more information >
Bi-Co Dietitian Special Diet Needs Form
Please let the Bi-College Dietitian know about any food allergies or special dietary needs that you have. Fill out the form, save it to your computer, and either email (npatience@brynmawr.edu) or to ensure confidentiality, print and mail the form to Nicole Patience (address listed at the bottom of the form).