Medical History, Physical, & Immunization Form

To provide the best possible medical care, we require each new student to have the Medical History, Physical, and Immunization form below completed by a physician, nurse practitioner, or physician's assistant.

Goucher's immunization requirements follow guidelines set by the American College Health Association and the Centers for Disease Control and Prevention. Immunization requirements may vary from state to state; we therefore recommend that your health care provider review our form carefully, assess your status, and update your immunizations as needed to fulfill our requirements. Please see Immunization Policy (PDF).

State law requires that any individual enrolled in a Maryland institution of higher education who resides in on-campus housing must be vaccinated against meningococcal disease, or must sign a waiver, which is included on the immunization form below.

Along with the medical history, physical, and immunization information, it is a requirement that all incoming students have health insurance and provide a copy of their health insurance information. All incoming students must complete and return these forms and provide their health insurance information to Student Health and Counseling Services on or before the assigned deadline listed on the New Student Experience Portal. Students who fail to return their forms, or who are not in compliance with our immunization requirements, will be notified and may be delayed in registering for classes.

If you have any questions, please call (410) 337-6050.

Download the Medical History, Physical, and Immunization Form:

Medical History, Physical, & Immunization Form (PDF)