APPLY TO MESSIAH

Forms

Engle health forms image

 

**New Students**

Please fill out New Student forms on the Health Portal.  All forms will only be accepted through the student portal.  We will not accept mailed or faxed forms.

Required:

  • Emergency Contact Information (on portal)
  • Tuberculosis Screening (on portal)
  • Immunization History (must manually enter and also upload a  copy from your Provider's office)
  • Medical History Form (on portal)
  • HIPAA Information Release Form (on portal)
  • Student Physical Form The Messiah University Physical Exam Form must be completed.  We will not accept any other physical exam forms.  Please be sure that the CLEARANCE BOX is marked regardless of your intention of playing intercollegiate sports.  This clears you for ALL activities on campus. (must be printed, completed by Provider, and then uploaded to patient portal)

 

Additional forms if needed: