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Health Forms


Please complete the following required health information. If you have questions please contact:

Office of Health and Wellness
650 Maryville University Drive St. Louis, MO 63141
Fax: 314.529.9906
Email:  nurspam@maryville.edu

COMPLETED Records need to be clearly scanned and emailed to pculliton@maryville.edu or faxed with your name and Maryville ID on each page to 314-529-9906.


ALL new students (excluding online students) must complete the Tuberculosis Screening sheet and return it to the Health and Wellness office before starting class
Required TB Tuberculosis Screening Form for all NEW students (excluding online students)

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

Students Living in University Housing

Health Student Record Form is required to be on file in the Health and Wellness office for the following students and turned in by 4 weeks before starting class:

  • 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.