Authorization to Disclose / Obtain Medical Records

Medical records are kept on file for 7 years following the discharge of a student.

• HIPAA Authorization for Release or Disclosure of Protected Health Information

If a healthcare provider's signature is required to complete documents a $20.00 fee is required. Please mail your document(s), the Authorization to Disclose Medical Records, and $20.00 check made payable to "Haverford College Health Services" to:

Haverford College
Health Services
370 Lancaster Ave.
Haverford, PA 19041

Required Physical Evaluation Form

• Physical Evaluation History Form

All physicals for the 2022-2023 academic year must be completed after June 1, 2022.

Lab Eligibility Clearance Forms

• Health Services BSL2 Work
• Health Services Animal Work

COVID-19 Screening

Utilized to assess patients symptoms prior to an appointment. Upload form to your HaverHealth Portal within 24 hours of your scheduled appointment.

• COVID-19 Pre-Visit Screening Form