Important Documents

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Health Insurance information

Ithaca College Aetna Student Health insurance brochure - ithaca-benefits-summary-2425 (pdf)

Summary of Benefits: Ithaca College Aetna Student Health plan for 2024-2025 school year.

2025-participating-insurance-list-ic.pdf - 2025-participating-insurance-list-ic (pdf)
2025 Cayuga Health/Ithaca College Participating Insurances - 2025-participating-insurance-list-ic (pdf)

Health Certification Forms for NEW STUDENTS

immunizationdocumentation_1.pdf - immunizationdocumentation_1 (pdf)

Immunization health form for Health Certification requirements

menn-response.pdf - menn-response (pdf)
Meningitis Disease Law information - Meningitisletter_1 (pdf)

Meningitis Disease Law information. Read details about requirements for meningitis vaccination in the college setting.

tb-form.pdf - tb-form (pdf)

Tuberculosis assessment form. 

hh_1-1.pdf - hh_1-1 (pdf)

Health History Form

Physical Form - PE FORM (pdf)

IC Physical form

universal-ic-roi.pdf - universal-ic-roi (pdf)

This form does require written signatures. 

minor-1.pdf - minor-1 (pdf)

Contains three forms. Consent for Treatment of a Minor, Notice of Privacy Practices Receipt, Meningococcal Meningitis Vaccination response form.

Immunization consent form for MINORS - ImmunConsent_0 (pdf)

If the student is under 18, this form must be filled out by a parent or guardian. Without this form the Health Center is unable to administer the immunization to a minor. 

Business Office Forms

Handicap Parking Permit DMV form - DMV6641 (pdf)

Handicap Parking Permit DMV form

Athletic Injury Form NCAA - accident-claim-form (pdf)

Participating in NCAA sport and are injured? Athletic Injury Form NCAA

roi.pdf - roi (pdf)

Release of Information Form for Medical Records

Complaint Form - PatientComplaints (pdf)

Have a comment or complaint? Please use this form.

Health Center Informed Consent for Telehealth - Health Center Informed Consent for Telehealth_4-24-2020 (pdf)
Notice of privacy practices - CMA notice of privacy practice (pdf)
medication-mental-health-ic-updated1.22.24.pdf - medication-mental-health-ic-updated1.22.24 (pdf)