Health Forms

Unless otherwise noted, all forms are available as PDF. If you do not have Adobe Reader 9 installed, click OK on the error message to open form and download.

  • Health Questionnaire: Return this completed form to Health Services before your first appointment.  This form is not the one to be used for athletic participation.
  • Health Record Release: We must have this form on record if you need your records sent out or received.
  • College Screening Questionnaire: Return this form prior to mental health screenings (including depression, ADD, or ADHD screening).
  • Gynecological Health Questionnaire: Return this form prior to gynecological health appointments (for female patients).
  • STD Questionnaire: Complete this form before calling to make an appointment if you want to have STD testing done through Health Services.

In Plymouth Magazine

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Ut Prosim: Burton for Certain

Ray Burton ’62 lived all his years in the North Country of New Hampshire. Few elected officials have ever understood the lifestyle and character of their constituents as well as he did or have known so many of them by name. On December 14, 2013, hundreds of Burton’s fellow citizens joined dozens of past and […]

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Faculty Forum: Brian Eisenhauer on Shrinking Our Environmental Impact

In his roles as professor, scholar, researcher, mentor, and campus leader, Brian Eisenhauer is at the center of Plymouth State’s sustainability and climate neutrality efforts. Under his leadership, Plymouth State has been consistently recognized as a leader in environmental sustainability and is regularly included in The Princeton Review’s Guide to Green Colleges, a compilation of […]

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Beyond Granite: The Museum of the White Mountains Takes on STEM

As American students and workers fall behind their counterparts around the world in the science and technology fields, educators and policy makers have stressed the importance of strengthening our attention to STEM—science, technology, engineering, and mathematics. Exhibition curator Sarah Garlick writes about the connections between earth science, adventure, and the process of learning STEM in […]