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 email@example.com. 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 Medical History Form (PDF)
- If you are a new patient, please also complete the New Patient forms (above).