Confidential Health Record

All incoming students are required to complete a medical history/physical and provide documentation of all required immunizations.

All incoming students are required to complete the confidential health record below. The physical must be current (within a year of starting at Ursinus) and signed by a healthcare provider. The confidential health record and meningitis waiver (if necessary) are due to the Wellness Center by July 30th, 2020. Please print off the forms and mail to Ursinus College Wellness Center 601 East Main Street Collegeville, PA 19426. 

Immunization for meningitis is required by law. A waiver is available above for students who do not wish to be immunized for meningitis. You ONLY need to sign and return the meningitis waiver if your confidential health record does not document receiving the vaccine. We strongly recommend immunization for HPV and influenza. 

Below is the complete list of vaccines that are Mandatory for Admission recommended by The American College Health Association.

  • Tetanus/Diphtheria (dT) or Tetanus-Diphtheria-Pertussis (DPT)
  • Hepatitis B 
  • MMR (Measles, Mumps, Rubella)
  • Polio
  • Varicella (Chicken Pox)
  • PPD
  • Meningitis


Information for Parents


Students that seek medical treatment at the Wellness Center have the option of signing a consent form allowing the Wellness Center providers to discuss medical care related issues with the students’ parents or legal guardians. If the consent is not signed, providers will not release any information to parent or legal guardian and refer the parent or guardian back to the student. Students may allow or revoke consent to speak with parents or legal guardians at any time.

Additionally, if the visit is sensitive in nature, the provider will not discuss the issue with a parent or legal guardian without explicit permission from the student.