Medical Forms

Health Form:

Immunization Record and Medical Information Form

To assist Emory & Henry in providing appropriate care, all undergraduate students are required to submit a completed six-page health form as provided by the college admissions office at the time of admission. PLEASE schedule an appointment with your provider to have your medical form completed as soon as possible. See page 6 of the form for submission options including via secure fax, 276-944-6666, or email our staff for additional options.  Varsity athletes, outdoor adventure team members, equestrian riders, club sport participants including rugby, cheer & dance must complete additional forms online through the ARMS system.

For any incomplete items on submitted forms, you will be contacted through your Emory & Henry EMAIL address.

*For School of Health Sciences graduate requirements see individual program information*

Minimum Required Immunizations or Proof by Titer:

  • MMR (Measles/Mumps/Rubella)
  • Polio
  • Tetanus-Diptheria (Td or Tdap) Booster must be within past 10 years

Commonwealth of Virginia Certificate of Religious Exemption Form must be completed and notarized if you have not received required immunizations: Religious Exemption Form

Strongly Recommended Immunizations:

  • Coronavirus (up-to-date)
  • Current year Influenza
  • Hepatitis A and B
  • Meningococcal (Quadrivalent and B)
  • Varicella
  • HPV (Human Papillomavirus)