Health & Wellness Form

St. Andrews Health and Wellness Form

This is confidential information and will not be released without your authorized permission.

  • This must include DTP, complete series of measles, mumps, and rubella immunizations, and completed meningococcal vaccine information.
  • I authorize the release of information to listed individuals and understand this authorization may include the need for St. Andrews University to share medical information to authorized individuals including mental and physical health issues.

  • Students over 18 years of age are responsible for signing their own form. Students under the age of 18 must have a parent sign the health form. All statements in this form are true to the best of my knowledge and I have no limitation or restriction in this record. I agree to notfiy St. Andrews University of any change that occurs in my physical or mental health. I give St. Andrews University permission to contact my parents, doctor, and/or pharmacy should the need arise. In the event that I transfer to another school, I give St. Andrews University permission to release my records to the appropriate authority.