Documents and Forms

Summary of Benefits: Ithaca College Aetna Student Health plan for 2023-2024 school year.

Immunization health form for Health Certification requirements

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

Tuberculosis assessment form. 

Notice of Privacy Practices Form

Health History Form

IC Physical form

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

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.