College Of William And Mary Student Health Evaluation Form
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7THE COLLEGE OF WILLIAM AND MARY
STUDENT HEALTH CENTER
P. O. Box 8795
Williamsburg, VA 23187-8795
Phone (757) 221-4386 / fax (757) 221-1245
E-mail:
sthlth@wm.edu
Dear Student:
Congratulations on your acceptance to the College of William & Mary. We look forward to serving your health
needs. To help us care for you, we need information about your health status. The Health Evaluation Form is
comprised of 3 sections that are due July 1st for those students entering the fall semester and January 10th for
those students entering the spring semester.
All full-time students, as well as any student eligible for services, are responsible for returning your health
evaluation form to the Student Health Center (Code of Virginia 23-7.5). This form will not be accepted if the
physician completing and signing the form is a family member.
Previously enrolled students, who are reentering as full-time students, after an absence from campus of greater
than 2 years must update their health form to meet current standards. If the absence is greater than 6 years, the
entire form requires resubmission.
For those seeking religious exemption, a Certificate of Religious Exemption (Form CRE-1) is the only form
accepted.
Omission or misrepresentation of pertinent medical information is a violation of the honor system.
FAILURE TO COMPLETE THIS REQUIREMENT WILL RESULT IN A “HOLD” BEING APPLIED TO
YOUR BANNER ACCOUNT AS WELL AS LATE FEES OF $100 ON AUGUST 31 FOR SUMMER/FALL
ADMISSION OR ON FEBRUARY 28 FOR SPRING ADMISSION.
Sincerely,
Student Health Center Staff
Student Health Center
College of William and Mary 230 Gooch Dr.
P.O. Box 8795 Williamsburg, VA 23187-8795 (757) 221-4386
Email:
sthlth@wm.edu
Revised 3/2016
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