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Need to make an appointment?

Book appointment (.png, 4K)
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
Returning students must enroll or waive health insurance each Fall before August 1. New students must enroll or waive health insurance the first semester of enrollment.  Your Wesleyan student ID will be required.  Waivers must be completed and approved on the Gallahger insurance website. Students who do not complete the approved waiver by the deadline will have the non-refundable annual insurance premium billed to their college account.  
Students who want to purchase Gallagher insurance (thru Wesleyan) must enroll on the insurance website before the deadline. 
Gallagher International Policy website (International Students) *Only the Gold Plan meets waiver requirements. 
ISO Care website  (International Students)  *Only the ISO Care for Wesleyan College Plan meets waiver requirements.
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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