Please complete the following to obtain all or part of your medical records. Form may be faxed or emailed to

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The Privacy Practices document is to be read (not to be submitted) and confirmation of receipt must be signed at the bottom of the Health History form. If you have any questions regarding the privacy practices, please contact Student Affairs. Thank you.

Privacy Practices Page 1 (read only)


Privacy Practices Page 2 (read only)

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For all daytime undergraduate students enrolled in at least 12 creditsinsurance applicable in the Macon, GA area is required. All such students must either "waive" or "enroll" in the Wesleyan College student group health insurance policy at Students admitting for Spring 2022 semester will be able to access the waiver or enrollment forms from December 1, 2021 - January 2, 2022; the insurance will be $1166 for the partial term.
NOTE: The waiver has closed for Fall 2021. Students who entered Fall 2021 and did not enter a waiver form must login at to setup a United HealthCare Student Resources account, access insurance card, provider list, and claims information. The Fall 2021 insurance charge is now nonrefundable.