Important Documents

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Health Insurance information

file-outline 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.

file-outline 2025 Cayuga Health/Ithaca College Participating Insurances - 2025-participating-insurance-list-ic_0 (pdf)
file-outline 2025 Cayuga Health/Ithaca College Participating Insurances - 2025-participating-insurance-list-ic (pdf)

Health Certification Forms for NEW STUDENTS

file-outline Immunization Form - required - immunization-provider-11.21.24 (pdf)

Immunization health form for Health Certification requirements

file-outline Meningitis Response Form - meningitis-11.21.24_0 (pdf)
file-outline Meningitis Disease Law information - Meningitisletter_1 (pdf)

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

file-outline Tuberculosis assessment form - required - TB FORM (pdf)

Tuberculosis assessment form. 

file-outline Health History Form - heath-history-11.21.24_0 (pdf)

Health History Form

file-outline Physical Form - PE FORM (pdf)

IC Physical form

file-outline Universal Communication Release Form - universal-roi-11.21.24_0 (pdf)

This form does require written signatures. 

file-outline Required Forms for Minors - minor-consent-11.21.24_0 (pdf)

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

file-outline 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

file-outline Handicap Parking Permit DMV form - DMV6641 (pdf)

Handicap Parking Permit DMV form

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

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

file-outline Release of Information Form - CHS-Release-Form-09_12_2021 (pdf)

Release of Information Form for Medical Records

file-outline Complaint Form - PatientComplaints (pdf)

Have a comment or complaint? Please use this form.

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