Downloadable Forms

For help filling out any of these forms, contact the Student Health Center at 540-458-8401 or studenthealth@wlu.edu.

Report of Health History and Physical Examination

The incoming first-year student should complete the first page of this form and take it to the physician at the physical examination appointment. The form should be returned by July 31st to: Student Health Center, Washington and Lee University, 204 W. Washington Street, Lexington, VA 24450-2116.

Immunization Record

The Immunization Record should be completed (in English) and signed by your healthcare provider. The form should be returned no later than July 31st, to: Student Health Center, Washington and Lee University, 204 W. Washington Street, Lexington, VA 24450.

Health Insurance Information Form

Students are required to provide evidence of adequate health and hospitalization insurance coverage to supplement the medical care provided by the University. The form must be returned no later than August 1st to Student Health Center, Washington and Lee University, 204 W. Washington Street, Lexington, VA 24450.

Medical Documentation for Special Housing Requests

Special housing is extremely limited. Only those students with the greatest medical need(s) will be recommended for special housing arrangements. In order to make this determination, it is important that the medical documentation supporting the request be complete.

Consent to Release Confidential Health Care Information

This form can be used to request that the Student Health Center share specific health information with another provider or another party (such as a dean or your parents), or to request that another provider share specific health information with the Student Health Center (such as immunization or treatment records).