Student Medical Forms

Click below to download and print student medical forms. If you have any questions, please contact the school nurse, Ms. Ann Gruber at (773) 881-6524 or email

Health Examination Form

Religious Exemption Form

School Medication Authorization Form

Asthma Action plan 

Allergy Action Plan

Seizure Action Plan

Sports Physical Form

Proof of School Dental Examination Form (Class of 2024 only)

Meningococcal Conjugate Vaccine

Saint Xavier University Health Center Information