Aquinas College Health Information Form

Health Information Form

Health Information Form
Student's Name

Please consider when completing this form that our knowing these matters could avert a serious problem, including saving your life. It is important that you outline any information that may be helpful to us in assisting you where needed.

1. EMERGENCY CONTACT

Address

2. ALLERGIES, FOOD INTOLERANCES & DIETARY REQUIREMENTS

3. HEALTH & WELLBEING INFORMATION

Our experience shows that knowing about a resident’s health history can be helpful should a problem arise. In some cases, students may not wish to indicate specific health issues in writing. If there are any health issues that you would like to discuss in confidence, please contact the College Dean.
Please tick relevant problem(s)

4. Do you wear a Medic Alert as a bracelet, necklace or tattoo on your body?

HEALTH DECLARATION

I confirm that this information form sets out any present medical conditions and the College is entitled to rely upon this form as being complete and correct. In the event the College is not able to contact my medical practitioner for advice, I hereby authorise the College to take appropriate action in good faith and will indemnify the College for any such action undertaken.