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Student Health Form Requirements

Health Services seeks to ensure a safe, healthy environment for the entire campus community. In order to do so, there are forms that are required of every undergrad and seminarian which you will find for downloading below. Please read everything carefully and submit the information by June 30.

Required Health Forms - New Students - Due June 30

For new undergraduate students and seminarians entering the Mount in the fall, the following forms are due at Orientation or not later than June 30. If you are unable to schedule a physical before this due dates, please complete pages 1,3, 4 and 5 and attach a note stating date of physical. Once physical is complete, please submit page 2 to health services. Please call us with any questions.

Print and complete these required forms:

Cover Letter  (.pdf) Important to read first
Health History Form (.pdf page 1)
Physical Examination Form (.pdf page 2)
Immunization Form (.pdf page 3) or Waiver for Immunizations (.pdf)
Meningitis Information/Waiver *  (.pdf page 4)
Emergency Information (.pdf page 5)

► New NCAA student-athletes are also required to fill out additional athletics forms.

* Effective June 1, 2000 Maryland law requires that an individual enrolled in an institution of higher education in Maryland who resides in on-campus student housing must be vaccinated against meningococcal disease.

Please mail your forms to:

Mount St. Mary's University
Attention: Health Services
16300 Old Emmitsburg Road
Emmitsburg, MD 21727

Faxed forms are not accepted!

Returning Students and Seminarians:

Returning students and seminarians must do the following:

► Inform Health Services of any changes in your health insurance plan;
► Inform Health Services of any changes in medications or diagnosis;
► Update your Emergency Contact information.

Health Services seeks to insure a safe, healthy environment for the entire campus community, we cannot impress upon you enough the importance of getting this information to us in a timely manner.

If you have any questions about Health Services or what is required, please call 301-447-5288 or email The Health Services staff is looking forward to having you as a part of the Mount St. Mary’s University family again.

16300 Old Emmitsburg Road | Emmitsburg, MD 21727
Map & Directions | | 301-447-6122
Frederick Campus | 5350 Spectrum Drive | Frederick, MD 21703
Map & Directions | | 301-682-8315