Health Forms

In order to comply with NH State Law and to provide you with quality health and wellness services while you are a student, we require that you complete the following forms. While all matriculating students will receive these forms in their pre-enrollment packets, we realize you may need additional copies. 

Please click on the links below, and print additional copies of the forms as needed.

Health Services Director letter to incoming students

Required Forms:

Health History Form

• The Student Health History Form includes demographic information, emergency contact information, and family and student health history.  We find that it is very helpful to bring this form with you for your scheduled physical exam, so that you can review this information with your healthcare provider.

Immunization Verification Form

• This form must be completed by the student’s primary care provider. Please look carefully at the required immunizations on the form to insure that your student’s immunizations are up to date.

Physical Exam Form

• This form should be completed by the student’s primary care provider. The student’s physical exam should be performed no more than 6 months prior to entrance at Daniel Webster College.

Patients Bill of Rights

• Please read this document and then sign on the back of the Health History Form, confirming that you have read and understand the Patient’s Bill of Rights.

Optional Forms:

Pre-order/Pre-pay vaccine form

• This form should be completed and returned if you would like to receive the annual influenza vaccine (highly recommended) in the Fall, or if you need other vaccines to be administered while you are at Daniel Webster College.