Forms

  • Student Health Evaluation Form
    All incoming students need to have a college entrance physical and complete the Student Health Evaluation Form before beginning classes at Luther.
  • Immunization Waiver Form
    This form is to be printed off and filled out by all students requesting immunization exemption. Please fill out entire form as directed and return to Health Service.
  • Release of Information
    This form authorizes Luther College to release a student's health records in the event that a he/she is referred to another physician, moves, or changes clinics.
  • Allergy Injection Information and Form
    Information regarding allergy injections in addition to form for providing permission to administer allergen immunotherapy.
  • Tuberculosis (TB) Risk Assessment Form
    The Tuberculosis Form must be completed by any incoming students before arriving at Luther.
  • Influenza Vaccination Consent Form
    Please print off this form and fill out prior to receiving the influenza (Flu) shot/mist.