Health History Record

Please print a copy of the required Health History Record. These 4-pages must be completed by all new students, including commuters. Mail the original, completed, and signed 4 pages to:

Randolph-Macon College
Student Health Services
PO Box 5005
Ashland, VA 23005

The Health History form for Fall 2017 must be completed no later than August 1, 2017.

All students under the age of 18 at the time of arrival on campus must also complete and return the Authorization to Treat a Minor form. This should be completed by a parent/guardian.

**Varsity Athletes: Make a copy of PAGE 4 and send it to:

Heather Bauby, ATC

Athletic Department

103 East Patrick Street

Ashland, VA 23005

(the original must come to the student health center)