All health forms for first-year and transfer students are due July 17, 2021.
Your physical exam must take place after August 1, 2018 (occurred within the last 2 years). If the required medical information is not received by the due date, your course registration may be at risk. Office copies of your physical exam results and immunization record are acceptable.
Student-athletes must submit two copies of a physical exam—one to Health Services and one to Athletics. Note, additional forms are required for first-year student-athletes. Questions, please contact Head Athletic Trainer Greg Steele at 508-286-3986.
Download and return your completed health forms by US mail to:
Valerie Tobia LICSW, MPH
Director of Counseling and Health Services
Norton, MA 02766
Faxing is unreliable and not recommended.
New Student Health Forms
- Student Health Services Personal Information (HF1)
- Health History (HF2)
- Meningococcal Vaccine Waiver (HF3)
- Tuberculosis Risk Questionnaire (HF4) – this form is two-sided and
may require healthcare provider’s signature based on answers provided
to screening questions
- Immunization Record and Physical Exam (HF5) – this form must be completed
and signed by your healthcare provider
- COVID-19 Status (HF6) – this form may require your healthcare provider’s signature
- Optional Medi-Alert Form (HF7)
- Sturdy Memorial Hospital Permission for Release of Disposition Information (HF8)
- Norton Medical Center Registration/Insurance Information (HF9)
- Copy (front and back) of private health insurance card
- Submit proof of flu vaccination – documentation should include name, date of birth, name of flu shot and date flu shot received, or medical/religious exemption form
All forms can be found in the link below:
Note: Please make copies for your records.
- If you are unable to schedule a physical exam before the July 17 deadline, please complete and submit the remaining forms accompanied by a note indicating the date of your scheduled physical. Forward the results of your physical exam as soon as possible.
- Your Immunization Record and Physical Exam and TB Risk Assessment forms must be signed by your healthcare provider. Immunization requirements differ from state to state. Please check with your primary physician to ensure receipt of all required immunizations.
- Requests for medical or religious exemptions may be granted in accordance with Massachusetts state law governing immunizations. In the event that there is an outbreak of any of these vaccine-preventable diseases, students who have been granted exemptions will be required to leave campus and will be readmitted when the period of communicability has passed. The Physical Exam/Immunization Waiver for Religious/Medical Reasons (pdf) may be downloaded and returned to Student Health Services.
- If you have not completed a multi-dose series of a certain vaccine (ex. Hepatitis B), receive as many doses as medically advised before arriving in August. Any outstanding doses may be administered during the academic year at Norton Medical Center, the student health center. Deductibles and co-pays apply and all charges will be billed to your insurance.
- If you have not received the Meningitis vaccine (MEN ACWY), you must sign the waiver form included in the New Student Health Forms document (linked above). This vaccine is strongly recommended. If you would like to receive the vaccine at any time during the academic year, the vaccine is available at the health center on campus. Deductibles and co-pays apply and all charges will be billed to your insurance.
Other important information
Housing Accommodation Information and Meal Plan Exemption Policy
Requesting Health Records
Wheaton College maintains copies of students’ immunization records for ten years from the date of graduation after which they are shredded. Copies of immunization records may be obtained without cost by contacting the Director of Counseling and Health Services at email@example.com.
Requests for copies of all other medical records may be requested by contacting Norton Medical Center’s medical records department at 508-285-9500 and by completing and submitting an Authorization to Release Health Information Form (pdf).
Wheaton’s Counseling Center
For concerns regarding accommodations under the Americans with Disabilities Act due to a medical, psychological, or learning disability, please contact Autumn Grant, Associate Director for Accessibility Services, at 508-286-8215 or firstname.lastname@example.org.
Norton Medical Center
For questions regarding Norton Medical Center, Wheaton’s designated student health center, immunizations, health insurance, or other health-related issues or if you would like to make an appointment to discuss a chronic health condition or serious illness, please contact Valerie Tobia, Director of Counseling and Health Services, at email@example.com.
Please visit gallagherstudent.com for information regarding the student health insurance plan offered by the college (Blue Cross Blue Shield of MA, Student Blue, Blue Care Elect PPO), the online waiver form (to opt out of enrollment), plan brochure, FAQs and other important information.