AStudent Downloadable Forms

• Initial Visit Health History Form
  Must be completed prior to first visit and returned at time of first visit to the Health Service.
• Pre-Travel Assessment Form
  This Form should be completed prior to your visit to the Health Service regarding this issue.

Freshman

• Freshman Immunization Form
  Must be completed and returned to the Health Service prior to start of the first freshman term. ** Required by all freshman NOT governed by special program immunization requirements.

Special Programs - School of Nursing

• Nursing Initial Health Form
  Must be completed and returned to the Health Service prior to the start of the first Undergraduate level term for the Nursing School as well as the start of any first Graduate level term for the Nursing School.
• Nursing Annual Health Form
  Must be completed and returned to the Health Service prior to March 1 on a yearly basis for all continuing Nursing Students.

Special Programs
School of Health and Rehabilitation Sciences

• SHRS Initial Health Form
• SHRS Annual Health Form

Special Programs - Miscellaneous

• Hepatitis B Refusal Form

Dietary Analysis

Free Dietary Analysis! Keep 3 days food and activity records and receive analysis and one-to-one recommendations with student Health Coaches! Download and complete these forms (below). Send the completed forms and any questions  to ATTENTION:  SHS Dietitian, Meg Mayer-Costa using the Form mailing address at bottom of this page.

• Food Recall Instructions
• Physical Activity Questionnaire

Please return any completed Student Downloadable Forms listed ON THIS PAGE to the following address:

University of Pittsburgh
Student Health Service
Medical Arts Building, Suite 500
3708 Fifth Avenue
Pittsburgh, PA 15213