Student Downloadable Forms

• Health Forms - Student and University Related
• Non-University Related

Pre-Visit Forms

• Initial Visit Health History Form
  Must be completed prior to first visit and returned at time of first visit to the Health Service.

Immunization Forms

Freshman

• Freshman Immunization Form
  Must be completed and returned to the Health Service prior to start of the first freshman term. ** Required by all freshman NOT governed by special program immunization requirements.

Special Programs - School of Nursing

• Nursing Initial Health Form
  Must be completed and returned to the Health Service prior to the start of the first Undergraduate level term for the Nursing School as well as the start of any first Graduate level term for the Nursing School.
• Nursing Annual Health Form
  Must be completed and returned to the Health Service prior to March 1 on a yearly basis for all continuing Nursing Students.

Special Programs - School of Health and Rehabilitation Sciences

• SHRS Initial Health Form
  
• SHRS Annual Health Form
  

Special Programs - Miscellaneous

• Hepatitis B Refusal Form
  

Please return any completed Student and University Related Health forms listed ON THIS PAGE to the following address:

University of Pittsburgh
Student Health Service
Medical Arts Building, Suite 500
3708 Fifth Avenue
Pittsburgh, PA 15213

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Revised 3/9/2006