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How to use or fill out All students are required to COMPLETE AND RETURN this health form with our platform
- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the 'Term of Entry' section, selecting either Fall or Spring and indicating your residency status as Resident or Commuter.
- 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.
- In the 'Medical History' section, answer questions regarding allergies, current medications, and any illnesses or disabilities. If applicable, provide details about major past illnesses.
- Complete the 'Family History' section by listing the age, occupation, and health status of your parents and siblings.
- Sign the 'Consent for Emergency Treatment' section. If you are under 18, ensure a parent or guardian also signs.
- 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.
- Review all sections for completeness before printing. Once finalized, print and return both pages to Student Health Services.
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See more All students are required to COMPLETE AND RETURN this health form versions
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2024 | 4.7 Satisfied (24 Votes) | |
| 2023 | 4.3 Satisfied (27 Votes) | |
| 2023 | 4.1 Satisfied (45 Votes) | |
| 2023 | 4.1 Satisfied (46 Votes) | |
| 2023 | 4.4 Satisfied (35 Votes) | |
| 2022 | 4.8 Satisfied (52 Votes) | |
| 2022 | 4.6 Satisfied (28 Votes) | |
| 2021 | 4.8 Satisfied (61 Votes) | |
| 2021 | 4.8 Satisfied (31 Votes) | |
| 2021 | 4.7 Satisfied (124 Votes) | |
| 2021 | 4.8 Satisfied (145 Votes) | |
| 2021 | 4.8 Satisfied (89 Votes) | |
| 2021 | 4.8 Satisfied (49 Votes) | |
| 2021 | 4.5 Satisfied (36 Votes) | |
| 2021 | 4.2 Satisfied (40 Votes) |
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How do you complete All students are required to COMPLETE AND RETURN this health form online?
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