Wheaton College Norton, Massachusetts
Wheaton College
Health & Wellness

Campus Life

New Student Health Forms

Freshmen and Transfer Students: The following health forms must be received by January 6, 2014. If the required medical information is not received by the due date, your course registration and housing assignment may be at risk.

Download and return your completed forms via email to maricle_cynthia@wheatoncollege.edu or mail to Cynthia Maricle, RN, Student Health Services Coordinator, Wheaton College, Norton, MA 02766. Faxing is not recommended. Please make copies for your records.

For more information, please refer to the Health Forms FAQs in the righthand column.

Welcome Letter from Jeff Klug, Director of Health and Counseling

HEALTH FORMS:

  1. Handy Health Forms Checklist (pdf)
  2. Personal Data Form (pdf)
  3. Physical Exam & Immunization Record (pdf) Office copies accepted. Hepatitis B, MMR, and Varicella vaccine series must be initiated before arriving on campus.
  4. TB Risk Questionnaire (pdf)
  5. Health History (pdf)
  6. Health Insurance Checklist (pdf)
  7. Norton Medical Center Registration Form (pdf)
  8. Study Memorial Hospital Disposition Information Form (pdf)
  9. 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) OR must sign this waiver form indicating that they decline the vaccine.
  10. Medi-Alert Form (pdf) Optional

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