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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:

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