Loyola University Maryland

Student Health and Education Services

Health Form

In order to provide the most efficient and appropriate medical care to our students, we require that ALL students complete the Student Health Services Health Form (downloadable PDF below) prior to the start of the first semester. The Student Health Services form needs to be completed and sent to our office (address below) by July 25, 2018. Please review the following instructions below for how to complete both parts of this form. 

STUDENT HEALTH SERVICES HEALTH FORM (PDF)

Part I: Must be completed by the student, parent or guardian.

Part II: Must be completed by your healthcare provider. 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. If your provider is submitting a print-out of your immunizations instead of using Part II of this form, please be sure that all required immunizations are included. Again, please be advised that students will NOT be permitted to live in campus housing without proof of immunity.

Please mail your completed Health Form to the following address:

Loyola University Maryland
Student Health Services
4502A North Charles Street
Baltimore, MD 21210