Health Information and Forms
Required Health Information Form
All new, incoming students must complete and return the Health Information Form to Student Health Services two weeks before their scheduled orientation date.
Compliance with and completion of this form is a Commonwealth of Virginia and Lynchburg College requirement for all full-time students.
Women's/Men's/Sexual Health Forms
These forms are only required if you make a GYN or men's health appointment.
Medical Release Form
Current LC students who need records to be sent to or received from other medical offices may fill out the medical release form and return it to Student Health Services by fax (434.544.8185) or email (email@example.com).
- Tetanus and Diphtheria Vaccine (Td or DPT): Must have a completed series with a booster of Tetanus/Diphtheria/Pertussis (TdaP) within the last 10 years
- Hepatitis B Vaccine: Must receive three (3) doses OR provide titer report indicating positive immunity.
- Two (2) MMR Vaccines (Measles, Mumps, and Rubella):
- administered after your first birthday AND after 1957,
- OR two (2) measles vaccines, one (1) rubella, one (1) mumps vaccine.
- All must have been administered after your first birthday AND after 1957,
- OR titer report indicating MMR immunity is acceptable in place of vaccine documentation.
- Meningococcal Vaccines: One vaccine is required on or after the 16th birthday
- Polio: Must have at least one dose
- Tuberculosis Screening:
- Must have risk assessment screening and/or Tuberculin skin test for those at high risk for tuberculosis,
- OR negative chest X-ray if history of prior positive TB skin tests.
Health Science Clinical Internships
Clinical Clearance Form to be completed upon request by the clinical director of your program.