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Medical Forms
(requires Adobe Acrobat Reader Adobe)

Health History Form
Each full-time undergraduate and every residential graduate student admitted to La Salle University receives a Health History Form. This form must be completed and signed by the student's doctor. This form also includes an immunization record, which must be on file in Student Health Center. The same requirements are applicable for any nonresidential full time graduate student who wishes to use the Health Center. Immunization requirements, based on recommendations of the American College Health Association, include:

-2 doses of MMR vaccine if born after 1956

-3 doses of DPT and tetanus booster (preferably the new Tdap vaccine booster) within the last 10 years

-3 doses of Hepatitis B vaccine

-2 doses of Varicella vaccine or a positive blood test is required ( history of disease IS acceptable)

-TB testing (PPD) for all nursing majors, education majors, and students living in high risk countries in the past five years
(S. America, C. America, Africa, Asia, E. Europe)

Registration will be delayed with a medical hold for any full time undergraduate student and any residential grad student until all health requirements are met (completed health form, proof of all required vaccinations and proof of health insurance).

Most vaccines are available at cost from the Student Health Center.

-Meningococcal Meningitis Vaccine or a signed waiver of declination is required of all residential graduate and undergraduate students and all full-time undergraduate commuter students.
(See Statement Below)

Meningitis Statement
Pennsylvania Law #955 was signed into effect in July, 2002 requiring all students living in university housing to receive the meningitis vaccine or to sign a waiver of refusal by August 30,2002. In addition, La Salle University, effective with the 2002-2003 academic year, requires all incoming students to receive the meningitis vaccine. If you are out of compliance with this requirement penalties will include restriction of registration for the next semester with a medical hold. Please contact the Student Health Center at 215 951 1565 for more information.