Prior to being on campus ALL students (new enrollment or transfer) must complete and submit the mandatory Medical History Form to:
Lock Haven University
Glennon Health Services
401 N. Fairview St
Lock Haven, Pa. 17745
Please make extra copies of this form.
If you play a sport have a copy for your coach and a copy for Health Services.
The form includes:
- Personal history
- Physical examination SIGNED by Primary Care Physician
- Immunization record
- Insurance information
Please note that certain areas of study may have different laboratory test requirements. Please consult your major to verify that you have all necessary immunizations and tests that are needed to fulfill the major requirements.
Release of Information
Any student, age 18 years or older, must come to the Student Health Service office and complete a written record release to obtain any medical records. This includes release of information to:
Depo Provera Injections
Glennon Health Services nursing staff can administer DepoProvera injections IF:
- Evaluation and initial injection was previously done by a Primary Care Provider
- Physician Assistant is on-site
- Student comes to Student Health Services during the dates indicated from prior injection
- Student brings documentation from Primary Care Provider of last injection date
- Student brings original prescription, in its unopened container, from the pharmacy
- Student is free of side effects or problems prohibiting the use of DepoProvera
- Student Health Services is not responsible for any costs incurred from any pharmacy for a DepoProvera injection.