All students are required to COMPLETE AND RETURN this health form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Term of Entry' section, selecting either Fall or Spring and indicating your residency status as Resident or Commuter.
3. Provide your personal information in the 'Personal History' section. Ensure you enter your name, Benedictine ID#, home address, phone number, and date of birth accurately.
4. In the 'Medical History' section, answer questions regarding allergies, current medications, and any illnesses or disabilities. If applicable, provide details about major past illnesses.
5. Complete the 'Family History' section by listing the age, occupation, and health status of your parents and siblings.
6. Sign the 'Consent for Emergency Treatment' section. If you are under 18, ensure a parent or guardian also signs.
7. Fill out the 'Immunization Record' section with your date of birth and have your healthcare provider complete their part. Make sure to include all required immunization dates.
8. Review all sections for completeness before printing. Once finalized, print and return both pages to Student Health Services.

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