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Haverford College
Health Services

Services: Forms

Contact Info

Mailing address:
Haverford College Health Services
370 Lancaster Avenue
Haverford, PA 19041-1392
U.S.A.

Fax: 610-896-1090
Phone: 610-896-1089
Website: www.haverford.edu/healthservices/
Email: Please email
hc-healthservices@haverford.edu.

Matriculation Requirements

Please do not call other departments on campus with Health Services related questions. The clinic is closed during summer but emails/voice mail/mail/faxes are processed weekly.

July 21 – All First Year Students

  1. Physical Examination (PE) Form PDF, including record of current immunizations. Please send the PE Form, completed by a health care provider (not a parent), to Health Services via fax or mail, or scan and email the form to both the administrative assistant and director.
  2. Confidential Health Record (available to complete when you get your student ID)
  3. HIPAA form PDF
  4. Financial Responsibility form PDF
  5. Authorize release of sickle cell trait newborn records. This form should be filled out by you and given to your health care provider. Also, please confirm your status via the mandated sickle cell Moodle site.
  6. Sports Medical Clearance Requirements
  7. If you will be younger than 18 years of age at time of arrival, your parent/guardian must complete the Consent to Treat a Minor Form PDF and send it to Health Services.
  8. Students must waive or enroll in College health insurance.
  9. Dietary Special Diet Needs Form
    Contact Nicole Patience, Registered Dietitian.
  10. Allergy Injection form PDF
  11. Special housing considerations
  12. Disabilities accommodation

A late fee of $75 will be charged for failure to submit fully completed health forms by July 21.

August 1 – Returning Students

All Haverford students are required to have proof of health insurance. Students must waive or enroll in College insurance plan.
*Be sure to look for an email confirmation after registering.

A late fee of $35 will be charged for failure to complete registration by August 1.

Students are responsible for all incurred medical expenses.Medical expenses are directly billed to insurance plan. Students can submit all charges to their student one card account or pay by check or cash.

Students should bring their insurance card, or copy of their card, with them during their first visits to the Health Center for us to scan into our system. Should a student drop or change coverage at any point during the school year submit change on line.

August 1 - International Students

Note that, from time to time, overseas health insurance has proven not to work in favor of students. Since the United States does not offer public health services for non-citizens, hospital costs can be alarming. Because Haverford requires its students to have adequate private health insurance, we highly suggest you purchase the College insurance plan.

Students must meet the Health Services requirement before arriving on campus for the International Students Orientation (ISO).

Animal Lab Eligibility Clearance Forms

Animal Lab Risk form PDF

Animal Lab Research Clearance-form PDF

Laboratory Biomedical Research Eligibility PDF

Other Forms You May Need

Records Release Form PDF
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 PDF
Should be printed, filled out, and brought to your appointment when receiving immunizations for travel. Visit Services: Travel Health for more information >