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
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 firstname.lastname@example.org. Please allow two business days for processing.
SXU Athlete Forms
- If you are a new student, please also complete the New Patient Forms (above).
- Health History
- Athlete Health History (PDF)
- Physical Exam
- Athlete Release of Information (completed yearly)
- Travel Medical History Form (PDF)
- If you are a new patient, please also complete the New Patient forms (above).