Insurance and Health Forms
The staff at the Student Health Center is committed to providing quality health care for the students of the Delaware Valley College campus. In order to accomplish this, we need accurate and up-to-date information on each student. This requirement is for full-time freshmen and students new to Delaware Valley College. Please be sure to complete these as soon as possible.
Enclosed please find (document at the bottom of this page):
- Physical and Immunization forms (PDF) to be completed by physician and student before you arrive.
- Insurance verification information for new students. All full-time students must enroll or waive the college's health insurance. If you do not go online starting soon (date to be posted shortly) and verify your insurance plan or enroll in the college plan, you will be put on registration hold. If you do not respond your account will be charged (charge to be posted shortly) which is non-refundable. The website will be available starting soon (date to be posted shortly). Coverage effective dates are between August 1, 2012 – July 31, 2013.
These forms are required for registration of all full time students.
Complete these forms in their entirety. Also, please be sure to complete all of the Immunization requirements, specifically:
- Tetanus within the last ten years
- MMR vaccine: two doses
- TB Test (PPD) within one year prior to entering college if determined necessary by your physician
- Meningitis vaccine for resident students
Be sure this form is signed and dated by both you and your physician in the appropriate spaces.
Please return the completed physical form to the Student Health Center no later than August 1 prior to the start of the Fall Semester. For transfer students, health forms from previous colleges may qualify. Also, most high schools keep immunization records for 5 years. Please have information forwarded to us if appropriate. Your former college, high school or doctor may fax your records to us at 215-230-2990.
If you have any questions regarding these forms, you may contact the Student Health Center Monday through Friday between the hours of 9:00 a.m. and 4:00 p.m. at 215-489-2252.
The Student Health Center requires a completed physical and immunization record. This is only required the first year at Delaware Valley College. These forms serve as a basis for providing medical care. If you are a transfer student, your former school may be able to provide this information.