Health History Form

Complete your Student Health Form and submit it by June 30!

  • Step 1: Read your Welcome Letter Summer ’16 for important dates and information!
  • Step 2: Complete pages 2-3 of your 2016 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 your completed Health Form and vaccination records to the Student Health Center by June 30!
    Mail to: La Salle University – Student Health Center, 1900 W. Olney Avenue, Philadelphia, PA 19141 or Fax to: 215-951-1566

*Failing to complete the mandatory Health Form requirements will result in a Medical Hold that will restrict you from registering for classes for the next semester!


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)

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