If you are unable to schedule a physical before this due dates, please complete pages 1, 3, 4 and 5 and attach a note stating date of physical. Once physical is complete, please submit page 2 to health services. Please call us with any questions.

PRINT AND COMPLETE THESE REQUIRED FORMS

• Cover Letter (.pdf) Important to read first
• Health History Form (.pdf page 1)
• Physical Examination Form (.pdf page 2)
• Immunization Form (.pdf page 3) or Waiver for Immunizations (.pdf)
• Meningitis Information/Waiver * (.pdf page 4)
• Emergency Information (.pdf page 5)
• New NCAA student-athletes are also required to complete additional athletics forms

Effective June 1, 2000 Maryland law requires that an individual enrolled in an institution of higher education in Maryland who resides in on-campus student housing must be vaccinated against meningococcal disease.

Please mail your forms to:

Mount St. Mary's University
Attention: Health Services
16300 Old Emmitsburg Road
Emmitsburg, MD 21727

Faxed forms will not be accepted

Returning students and seminarians must do the following:

• Inform Health Services of any changes in your health insurance plan;
• Inform Health Services of any changes in medications or diagnosis;
• Update your Emergency Contact information (.pdf).
• Returning NCAA student-athletes are also required to complete additional athletics forms

Health Services seeks to insure a safe, healthy environment for the entire campus community, we cannot impress upon you enough the importance of getting this information to us in a timely manner.

The Health Services staff is looking forward to having you as a part of the Mount St. Mary’s University family again.

A well informed patient is able to make better decisions about their health. At Health Services we want to be sure you're fully informed so you can make the right decisions for your own health.

Here are some helpful details about important medical topics that students and parents ask us about.

• Vaccine Information (.pdf)
• Ticks and Lyme Disease (.pdf)