Health History Form

Requirements

All students are required to have a completed health record form signed by both the student and his/her physician on file with the Health Center before the start of classes.

This includes:

• A physical examination exam

• Completed immunization record

Required immunizations include MENINGITIS, measles (rubeola), German measles (rubella), mumps, tetanus/diphtheria (within the past 10 years), polio series and a tuberculosis screening test. It is recommended that each student speak to their health care provider regarding immunization against meningitis and varicella (chicken pox). Hepatitis B, and varicella vaccines are recommended but not required.

Download a printable .pdf file of the Health History Form.