Medical Record Form

All undergradute students are required to submit a completed medical record form in its entirety plus a record of immunizations upon admission to the University. Any student who has had a break in matriculation of two or more semesters must resubmit the same. All students participating in Hampton University-sponsored special summer programs are required to submit completed medical forms and a record of immunizations. This does not apply to regular summer session students.

Physical examination (part iii - vi) must be submitted on the university form. Faxed copies of the medical record form are not acceptable. Please make a copy of medical form for your records.

Download the Health Center Medical Record Form  (3 pages)

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