Medical Forms

Health Form:

Immunization Record and Medical Information Form

To assist the college in providing appropriate care, all undergraduate students are required to submit a completed six-page health form as provided by the college admissions office at the time of admission. We understand that primary care offices are limiting appointments during this time of physical distancing. PLEASE go ahead and call now to schedule for an early summer appointment with your provider so you can have the medical form completed. Varsity athletes, outdoor adventure team, rugby, and cheer&dance affinity program participants must complete additional paperwork online at

For any incomplete items on submitted forms, you will be contacted through your Emory & Henry College EMAIL address.

*For School of Health Sciences graduate requirements see individual program information*

Minimum Required Immunizations or Proof by Titer:

  • MMR (Measles/Mumps/Rubella)
  • Polio
  • Tetanus-Diptheria (Td or Tdap) Booster must be within past 10 years

Commonwealth of Virginia Certificate of Religious Exemption Form must be completed and notarized if you have not received required immunizations: 

Strongly Recommended Immunizations:

  • Coronavirus (REQUIRED FOR SPECIFIC GROUPS—see below)
  • Current year Influenza
  • Hepatitis A and B
  • Meningococcal (Quadrivalent and B)
  • Varicella
  • HPV (Human Papillomavirus)

An FDA approved coronavirus vaccine, whether still in Emergency Use Authorization status or not, will be required for all students under the following circumstances:

  • Students living in College-owned residential facilities
  • Students that are members of an NCAA athletics team Students involved with any affinity group or club sport Student members of the equestrian team
  • Students involved in any active student organization, to include fraternity and sorority life, and any student organization recognized by the
  • Student Government Association Students that are representing the college in any visual or performing arts program
  • All School of Health Science students
  • All School of Nursing students

Students that are on the Emory campus will need to report their vaccination status no later than July 1st. Students that are on the Emory campus will need to use this form to submit that information.

Students at the School of Health Sciences should upload their vaccination status in E-Value by August 1st. If you do not have access to this link, please consult with Dr. J.P Barfield.

Students at the School of Nursing should upload their vaccination status in Castlebranch. If you do not have access to this link, please consult with Dr. Laurie Anne Ferguson.

Students may request a religious or medical exemption by July 1st. Please note that all medical exemption requests require documentation from a healthcare professional (MD, DO, NP or PA) Further, please note that any religious exemption must be notarized. You may submit religious and medical exemption requests here. Should you be granted an exemption, you will be required to wear a facial covering at all times in enclosed spaces until the CDC indicates otherwise.

If you have any questions, please do not hesitate to reach out to Ryan Bowyer at

Find a vaccination location near you: