Student Medical Forms

Click below to download and print student medical forms. If you have any questions, please contact the school nurse, Mrs. Amanda Gaida RN '93 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

Meningococcal Conjugate Vaccine

Saint Xavier University Health Center Information