New Student Health Forms
Freshmen and Transfer Students: The following health forms must be received by JANUARY 11, 2012. If the required medical information is not received by the due date, your course registration and housing assignment may be at risk.
Please download and return your completed forms via email to maricle_cynthia@wheatonma.edu or snail mail to Cynthia Maricle, RN, Student Health Services Coordinator, Wheaton College, Norton, MA 02766.
HEALTH FORMS
Welcome Letter from Student Health Services Director and Associate Dean of Health & Wellness, Craig S. Andrade.
- Handy Health Forms Checklist (pdf)
- Personal Data Form (pdf)
- Immunization Record & Physical Exam Form (pdf) Office copies accepted. Hepatitis B, MMR, and Varicella vaccine series must be initiated before arriving on campus.
- Health History Form (pdf)
- Health Insurance Checklist (pdf)
- Norton Medical Center Registration Form (pdf)
- Sturdy Hospital Release Form (pdf)
- Meningitis Waiver Form and important information (pdf)
All newly enrolled full-time students must provide written documentation of one dose of Menomune (MPSV4) in the past 5 years OR a dose of Menactra (MCV4) at any time in the past (unless they have signed a medical or religious exemption below) OR must sign this waiver form indicating that they either elect to decline the vaccine or could not obtain the vaccine, but wish to receive it. - Medi-Alert Form (pdf) Optional
- Dining Services Needs Form (pdf) Optional
