Important Forms

Health Evaluation Form

Health Evaluation form contains the following:

  • Student Report of Medical History and Tuberculosis Screening - to be completed by student.
  • Medical Practitioner's Report of Health Evaluation -Physical Examination to be performed by your own health care provider.
  • Immunization record - To include all vaccines and immunizations.
Medical Release Form

Copies of medical records require written permission before they can be released to your family doctor, specialists, etc. Download and fax to Health Services if you request your records be sent to another provider.

Follow the steps below:

  1. Click on the desired form
  2. Print it out
  3. Fill out the information
  4. Return it to the Health center using the following address or fax:

    Health Services
    Millersville University
    P.O. Box 1002
    Millersville, PA 17551-0302
    Fax: (717) 871-2243

Personal Medical Records are not to be transmitted electronically to Health Services. Please mail or fax any personal medical information to maintain confidentiality.

It is a REQUIREMENT for each incoming student to have a completed Health Evaluation Form on file in the Health Services.