Health & Wellness Center

Health Center Forms

• New Student Letter
• Medical History Form
• Meningitis Vaccine Information Sheet
• Tuberculosis Questionnaire
• Tuberculosis Risk Assessment
• Physical Form
• Consent form to share information with parents/guardians
• Consent form for release of medical records

Requirements:

Alvernia requires all students to submit a Medical History Form with a record of their immunizations and a Tuberculosis Questionnaire prior to August 1st.

All professional majors (nursing, occupational therapy, athletic training) and student athletes are required to have a physical exam, as well as some additional vaccines.

Any student living in the university residence halls are required to have a meningitis vaccine within the past 5 years or sign a waiver denying the immunization.  The meningitis vaccine is strongly recommended for all commuter students as well.

The Health & Wellness Center follows FERPA and HIPAA regulations regarding the confidentiality of your medical record.

• If you would like for us to communicate freely with your parents/guardians, please fill out a release of information form and give it to a Health & Wellness Center staff member to keep on file with your medical records. This release of information may be revoked if you decide that you no longer want information to be shared with your parents/guardians.

• If you require your medical records to be released to another party, we will be glad to do so, but we do require a consent form be filled out. Please be sure that this form includes the name and address to whom you would like your records sent, as well as, the date, your name, signature, and date of birth.