Health Forms

Please complete the following records 4 weeks prior to arriving on campus. For more information, please contact: Office of Health and Wellness 650 Maryville University Drive St. Louis, MO 63141 Phone: 314.529.9556 Fax: 314.529.9906 Email: smcintyre@maryville.edu or nurspam@maryville.edu

Health Record Form is required to be on file in the Health and Wellness office for the following students:

Students Living in University Housing

Please send 4 weeks before move in:

  • Physical exam less than 1 year old, on file (not required yearly)
  • Documentation of 2 doses of Measles, Mumps and Rubella, Tetanus/diphtheira or Tdap within the past 10 years and Meningitis vaccination or formal declination Meningitis Vaccine Documentation or Waiver form
  • Meningitis Information Sheet All students living in University housing must either get a meningitis vaccination or formally decline; Indicate if you had chickenpox or document 2 doses of Varivax
  • Tuberculosis testing within the past year with results (see form for details)
  • Student Health Form

Division II Athletes, Dance and Cheerleaders

If you live on campus – you will need a TB test/results and you will need to fill out the meningitis form.  Send in 4 weeks before moving in.  

  • Annual physical exam while participating in Division II athletics, Dance or Cheerleading
  • Documentation of 2 doses of Measles, Mumps and Rubella, Tetanus/diphtheira or Tdap within past 10 years on file and note Chickenpox disease or document 2 doses of Varivax (Chickenpox vaccine)
  • Student Health Form

Health Professional Students in Clinicals

See details on form or talk with your advisor about the requirements that will be due before you engage in your clinical/practica experience.  If you are not living on campus you do not need to get the meningitis vaccine.

Students can now see their health form and print it off here.