Health Record Form, Countdown to Earlham | Earlham College Skip to Content


The Earlham College Health Services office must have a completed Health Record form for all enrolled students. Complete this process by following these steps.

  1. Review Earlham's Health Record requirements.
  2. Download and complete Earlham's Health Record form.
  3. Email or upload your completed form before you arrive on campus.
  4. August Wilderness participants only must download and complete the Physician Physical Form.

Mail your completed health record to:

Health Services
Earlham College

801 National Road West
Richmond, IN 47374-4095

Scan your completed form as a PDF and upload it online here.

Questions or Problems?

If you're having issues completing the Health Record form, contact
Mary Ann Stienbarger
Director of Health Services

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