Please read the following options carefully, and select the appropriate forms to download.

2018-2019 Health Forms and New Student Requirement Letters

New student greetings letter from Dr. Goldstein

To ensure that all your forms are completed, please refer to our “To-Do List”Review the health forms To-Do list

Required Medical Forms

Download the Immunization Record Form

Download Tuberculosis Screening Form

Download the Physical Examination Form

Once these forms have been completed by your healthcare provider please upload them onto the Patient Portal .

Other Forms Required (electronically)

The Bailey Health Center utilizes an electronic health record system to keep track of vital health information on each student. You will need to access this system through the Online Patient Portal.

Enter your network ID and password in the OP portal.

Complete the following forms online:

  • Health History Form
  • Emergency Notification Form  
  • Privacy Acknowledgement

Insurance (Required)

Download Insurance Letter

Download the Insurance form, complete then upload directly to your Patient Portal

**ALL REQUIREMENTS MUST BE COMPLETED ON OUR PROVIDED FORMS**

Adobe Acrobat Reader is required for viewing and printing the Lafayette College Health Forms. If you do not have Acrobat Reader installed, please download Acrobat Reader from Adobe’s website.

Air Conditioning Request

Air conditioning is limited in some residence halls and students are not permitted to have air conditioners installed in their room except for rare cases of documented medical condition or disability. If your residence hall does not have a central air conditioning system and you require it for a medical condition or disability please have your medical provider complete the form below and return it to the Bailey Health Center.

Air Conditioning Request Form