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.

Enclosed please find (document at the bottom of this page):

1. Physical and Immunization forms (document at the bottom of this page) to be completed by physician and student
2. Insurance verification information yearly. All full-time students will receive information from Hulse/QM to verify insurance coverage. If this is not provided by a certain date, you will be charged for the school insurance policy. The website is www.hulseqm.com.

These forms are required for registration of all full time students: resident, commuter, transfer and all athletes (full and part-time).

Complete these forms in their entirety. Please complete all of the Immunization requirements, specifically:

1. Tetanus within the last ten years
2. MMR vaccine: two doses
3. TB Test (PPD) within one year prior to entering college if determined necessary by your physician
4. 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 by 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.
Click on the PDF files below to download and view (Please note: the following documents must be viewed using Adobe Reader. To obtain Adobe Reader free of charge, please visit Adobe's website).

Physical Examination Form

The Student Health Center requires a completed physical and immunization record. This is only required the first year. These forms serve as a basis for providing medical care. If you are a transfer student, your former school my be able to provide this information.