Health History Form and Immunizations

Health History Form

Health history forms must be completed by August 1. 

  • Step 1: Read your Welcome Letter Summer ’22 for important information!
  • Step 2: Complete pages 2-4 of your 2022-23 Student Health Form and have your healthcare provider complete page 1 OR attach an official copy of your vaccination records to your health form.
  • Step 3: Mail or fax your completed Health Form and vaccination records to the Student Health Center by August 1. Completed forms may be faxed to 215.951.1566 or mailed to the following:

    ATTN: Student Health Center
    La Salle University
    1900 W. Olney Ave, Box 419
    Philadelphia, PA 19141

PLEASE NOTE: Failing to complete this form in time will result in a medical hold that will restrict you from registering for classes.


Immunization Requirements

Immunization requirements, based on recommendations of the American College Health Association, are required for every full-time day undergraduate student and any residential student (graduate or other programs).

Required vaccinations include:

  • 3 doses of DPT and tetanus booster (preferably Tdap) within the last 10 years;
  • 2 doses of MMR (measles, mumps, rubella) vaccine if born after 1956 OR positive blood tests tests for IgG titers;
  • 3 doses of hepatitis B vaccine or a positive blood test for hepatitis B surface antibody titer;
  • 2 doses of Varicella if born after 1979, history of chickenpox disease, or a positive blood test for Varicella IgG titer;
  • Tuberculosis testing (PPD, T-Spot, or Quantiferon Gold) for all nursing majors, education majors, and students living in high risk countries (S. America, C. America, Africa, Asia, E. Europe and parts of W. Europe);
  • Meningococcal Meningitis Vaccine (Type A, C, W-135, Y) or a signed waiver of declination;
  • Type B Meningitis Vaccines is recommended but not required;
  • Up-to-date COVID-19 Vaccination
    • Completed primary immunization of SARS-COV2:
      • 2 doses of Moderna or Pfizer-BioNTech
      • OR 1 dose J&J/Janssen
    • 1 booster of Pfizer-BioNTech or Moderna if more than 5 months since completion of primary immunization.

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