Health History Record

Please print a copy of the required Health History Record. These 3-pages must be completed by all new students, including commuters. Upload the completed health history record to the following online patient portal:

FREE scanner apps are available for apple and android phones. Search the app store for "scanner" in the event you do not have a scanner.  Public Libraries also are options for scanning purposes.

In the event that you are unable to upload your form to the secure patient portal please Mail the original Health History Record to:

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

The Health History form for Fall 2018 must be completed no later than August 1, 2018.

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: visit

in addition to the health history form.