Health History Form

All students are required to submit a Health History form upon admission to Averett University.  Information on the form is used to ensure that we have the most updated health information so that we can provide the most appropriate care for our students.   All information contained on the Health History Form is intended for medical services only and will be maintained as confidential information in your student health record.  The information will not be released without your written consent, except in cases of life threating emergencies.

New/Transfer Students

Every new or transfer student MUST complete the Health History Form.  This Adobe sign form can be completed online and securely emailed to [email protected].

Returning Students

All returning students must submit an updated Health History Form at the start of every fall semester.

Immunization Documentation

The Code of Virginia Law requires certificate of immunizations and Tuberculosis (TB) screening be completed and submitted to Health Services.  All students should submit the Immunization Form and any documentation securely to [email protected] by August 30th for Fall or Jan 17th for Spring.  Any student failing to submit the required documentation by the deadline will have an Academic Hold placed on their Student Account.  This means you will not be able to register for the upcoming semester until all documentation has been received.

Part 1 Immunization Requirements:

You may submit documentation of immunizations in one of two ways.

  • Submit an official immunization record from your doctor, school transcript, health department, etc.
  • OR print Immunization Record Form and have Part 1 filled out & signed by a licensed healthcare provider.

Part 2 TB Screening:

  • Answer all questions under this section of the Immunization form and submit any required documentation as indicated on the Immunization Form.

International students should verify that your Immunizations meet all of the requirements of Averett University prior to arrival on campus.  Information on the required immunizations can be found on the Immunization Form.  For information on immunizations, please check out information on the Centers for Disease Control website

If you have questions, please contact Health Services at [email protected] or by phone 434-791-5824.