Allergy Injection Forms


The following forms can be downloaded and completed prior to your scheduled appointment.   Please follow additional form requirements that may be listed next to each link.

Required Forms For Allergy Injections

Students who require allergy injections can make arrangements with our Student Health Service clinic.   However, to ensure safe and timely administration of allergy immunotherapy, an ALLERGY INJECTION CHECKLIST form must be completed by the student’s clinician and sent to us before arrangements can be made.


Should you have questions, do not hesitate to call the Student Health Service at 412-383-1800.


Please print out the following forms and submit them to your Physician who is managing your allergy:

Return completed forms to the Health Service via one of the following methods listed below:

U.S. MAIL: University of Pittsburgh
Student Health Service
Nordenberg Hall – Wellness Center
119 University Place
Pittsburgh, PA. 15260
Delivery in Person: Do NOT Email or FAX. We cannot accept these forms via EMAIL or FAX !!