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

If you are an incoming freshman family, please find your medical forms here, under the "Essential Documents" tab.

Yearly Alert - Medications and Medical Conditions

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 (Incoming Freshmen Only)

Meningococcal Conjugate Vaccine

Saint Xavier University Health Center Information