Health Center Forms

If you are able to come to your appointment with the appropriate forms filled out you will save valuable time. Please call 773-298-3712 with any questions.

New Patient Forms

Please read our Consent to Treatment (PDF) carefully and then fill out:

• Patient Registration and Consent Form (PDF)
• Medical History (PDF)

Release of Information

• Release of Information (PDF)
• Complete this form if you need your health information sent to the SXU Health Center or if you need the SXU Health Center to send your health information to a third-party.
• The completed form can be dropped off at the Health Center, faxed to 773-298-3906, or emailed to healthcenter@sxu.edu. Please allow two business days for processing.

SXU Athlete Forms

• Please see the SXU Athlete Physical page for all information about athlete physicals, including all forms

Travel Medicine

• Travel Medical History Form (PDF)
• If you are a new patient, please also complete the New Patient forms (above).