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Medical History Report

All students must submit the completed Medical History Report for approval prior to enrollment at Lock Haven University. Download and print the form (link below) and take it to a physician.

Important: This form must be approved by Health Services at Lock Haven University before a student can be enrolled in classes.

The information on the Medical History Report is for the use of Health Services and will not be released to anyone without your knowledge and consent except as permitted by the Family Education Rights and Privacy Act of 1974 and Health Insurance Portability and Accountability Act of 1996 (HIPPAA) or as required by law.

Download the Medical History Report form (Adobe PDF file).

If you do not have Adobe Reader, click here for a free download.

If you have any questions on the Medical History Report please contact the LHU Infirmary at 570-484-2276 or visit their website at www.lhup.edu/health/index.htm.