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 must be filled out to be considered complete.

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.
  • MM slash DD slash YYYY

  • Health Insurance Information

    Please provide copy of Insurance Card

  • Medical History

    have you had or are you experiencing any of the following? (Please explain below)

  • 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

  • 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

Welch College does not discriminate on the basis of race, gender, color, national and ethnic origin, age, or disability in admitting students or in otherwise administering its educational policies and school-sponsored programs.