Health History

Health History

All students are required to file a current health record with Welch College at the time of enrollment. This information is confidential. All sections much be filled out to be considered complete.

Check all that apply:(Required)
Name
MM slash DD slash YYYY
Emergency Contact(Required)
Emergency Contact Home Address(Required)

Health Insurance Information

Please provide copy of Insurance Card
(Required)
Insurance Company Address(Required)

Medical History

have you had or are you experiencing any of the following? (Please explain below)
Check all that apply:(Required)

Medications You are Taking Regularly

List all prescribed and over the counter medications, including vitamins &/or herbs, body enhancing formulas, and diet pills

Family History

Has anyone had or does anyone have any of the following in your immediate family: (Please explain below)

Health Form Agreement

I affirm that any optional information withheld or erroneously reported will make it difficult to receive effective medical treatment and I therefore waive any liability on the part of Welch College related to absence or error in such information.
MM slash DD slash YYYY

We’re Here to Help!

Ms. Abby Settle

Ms. Abby Settle

Admissions Counselor

Mr. Alejandro Johnson

Mr. Alejandro Johnson

Admissions Counselor

Daniel Webster welch college, gallatin, TN

Mr. Daniel Webster

Director of Enrollment Services | Adjunct Instructor

Ms. AnnaGee Harris

Ms. AnnaGee Harris

Director of Theater | Coordinator for Enrollment Events and Student Reps

Mrs. Pam Buck

Mrs. Pam Buck

Coordinator for Admissions Records

We are a Christian Community of Faith and Learning

At Welch College, we provide a unique setting for preparing student-leaders to serve God in whatever field He is calling them to.

In this Christian community of faith and learning, students find their place in God’s world, and we equip them with the tools to fulfill that calling.

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