Medical Forms and Waivers

Students should complete and return forms to: Kenyon College Health and Counseling Center, 104 W. Scott Lane, Gambier, Ohio 43022.

Medical Health History Form (PDF)

Immunization Waiver (PDF)

Consent for Release of Information (PDF)

Insurance Claim Form (PDF)

Conway's Eastside Pharmacy Prescription Form (PDF)

Consent to Treat Minor Patients (PDF)

Return from Medical Leave Form (PDF) 

Counseling Services Information Packet (PDF)

Telemental Health Informed Consent (PDF)