Health History Form

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Health History Form Each full-time undergraduate and any residential 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. Immunization requirements, based on recommendations of the American College Health Association, 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)

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

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