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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. To avoid late fees please note firm DEADLINES. All Physical Exams must be completed after January 1, no exceptions.

July 21 – All First Year Students

  1. Physical Examination (PE) Form PDF, including record of current immunizations.
  2. Confidential Health Record (submit on Health Portal)
  3. HIPAA form PDF
  4. Financial Responsibility form PDF
  5. Required class and confirm your status via the mandated sickle cell Moodle site.
  6. Sports Medical Clearance Requirements
  7. If less than 18 years of age at time of arrival, required Consent to Treat a Minor Form. PDF
  8. Required - waive or enroll in College health insurance.

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 are required to have health insurance that works within a ten mile radius of the campus. 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, pay by check, cash or credit card.

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.

Waive or enroll in College insurance plan.
*Be sure to look for an email confirmation after registering.

A late fee of $40 will be charged for failure to complete registration by August 1.

August 1 - International Students

All international students are required to purchase the College insurance plan.

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 >

Animal Lab Eligibility Clearance Forms

Animal Lab Risk form PDF

Animal Lab Research Clearance-form PDF

Laboratory Biomedical Research Eligibility PDF