Loyola University Maryland

Student Health and Education Services

Health Form

Students must complete the Student Health Services Health Form (downloadable PDF below) prior to the start of the fall semester. The Student Health Services form needs to be completed and mailed or faxed to our office (address below) by July 25, 2019.  Spring Transfer students must complete and return the Health Form by January 10, 2020.  Please review the following instructions below for how to complete both parts of this form. Please submit the form only when both Part 1 AND Part 2 are complete.


If you need assistance completing this form, please contact the Student Health Services department at 410-617-5055.

  • Part I: Must be completed by the student, parent or guardian.
  • Part II: Must be completed by your healthcare provider. Please note that print-outs/attachments can supplement, but NOT substitute for form completion. 

We recommend that you make an appointment with your provider as soon as possible. This is so that you can receive any necessary vaccinations and so that you also able to return your completed health form by the required July deadline. Please note if your forms are late or not-received, this may cause a delay with your housing assignment/moving-in process.

Please mail or fax your completed Health Form to the following address:

Loyola University Maryland
Student Health Services
4502A North Charles Street
Baltimore, MD 21210
Fax: 410-617-2173