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Student Health Form

Submit the completed Student Health Form by July 15, 2014.

Transylvania University requires every entering student to complete the student health form, which includes a personal health inventory, record of immunizations, and documentation of a physical examination completed by the student’s physician within 12 months prior to arrival on campus.

First-year students! Call now to arrange an appointment with your health care provider.

If you have history of a chronic disease, disability, or illness, please submit documentation from your health providers addressing your diagnosis and treatment plan. This information is essential for your safety and well-being, as well as continuity of care, should you have any medical needs that arise while you're on campus.

All records are kept confidential and secure. View our notice of privacy practices.


It’s as easy as 1, 2, 3…

But you'll want to start now! Complete the following steps to make sure you have all of the forms completed by the July 15 deadline.

  1. Contact your health care provider to make an appointment for a physical examination.
  2. During your appointment, ask your physician to complete and sign Section 1 of the Student Health Form (pages 1-5).
  3. Complete and sign Sections 2 through 4 of the Student Health Form (pages 6-9).
  4. If you are under 18, have your legal guardian complete page 10.
  5. Mail or fax all pages of the completed form to Transylvania before July 15, 2014.

Questions? (859) 281-3682

Mail forms to:

Health & Wellness Center
Transylvania University
300 North Broadway 
Lexington, KY 40508-1797

Or fax to:

(859) 233-8101


Transylvania’s Health and Wellness Center

Our goals are to provide accessible and timely primary care that is personalized and confidential and to educate our students, emphasizing health promotion, healthy lifestyles, and lifelong disease prevention.

Visit the Health and Wellness web page for more information.

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Transylvania University admits students regardless of age, race, color, ethnicity, religion, gender, sexual orientation, disability, veteran status, national origin, or any other classification protected by federal or state law or local ordinance.