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Need to make an appointment?

Book Appointment (.png, 1K)
Request for Medical Records

Please complete the following for to retain all or part of your medical record. Form may be faxed or emailed to

Release form (.pdf, 131K)
Student Medical Forms (required for new students)

Meningitis form to be completed for students living on campus ONLY. Privacy practice document is to be read and confirmation of receipt signed at the bottom of the Health History form. If you have any questions regarding the privacy practices please contact the health center. 

Health History (.pdf, 187K)
Physical exam form (.pdf, 87K)
Immunization form (.pdf, 134K)
Privacy practices (.pdf, 157K)
Health Insurance Waiver/ Enrollment
Gallagher Benefits Information 2017-18 (.pdf, 368K)
Gallagher International Policy Information 2017-18 (.pdf, 286K)
ISO Care for Wesleyan College Brochure 2017-18 (international Students Only (.pdf, 300K)
Gallagher Brochure 2017-18 (.pdf, 141K)
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