Requirement
All full time undergraduates, including transfer students, and all international graduate and undergraduate students are required to submit a completed physical examination and medical history form prior to their first class attendance. Physical examinations must done and dated after March 1, 2009 for fall 2009 attendance and after August 1, 2009 for spring 2010.
Deadlines for Submission
If first attending in the fall 2009, physical examination forms must be completed and returned to Student Health by July 31, 2009
If first attending in the spring 2010, forms must be competed and returned to Student Health by January 1, 2010.
Non Compliance
Students who do not submit a complete physical examination form will have a registration hold placed within 30 days of the start of their first semester at Canisius. This means the student can not register, add or drop courses, attend class and reside in the residence halls. This is strictly enforced.
Physical Examination Form
| The above video requires QuickTime. If you do not see the video start to play after a few seconds, you may need to download QuickTime here. |
The first section, "the medical history", the student must complete and sign. If a student is under the age of 18, their parent or legal guardian is responsible for completing and signing this section. The medical history includes the following:
Demographic information
Emergency contact
Physician name and contact information
Health Insurance
Meningitis response
Authorization for treatment
Past and current medical conditions, medications, allergies, surgeries
Family medical history
The second section "Immunizations and TB screen", must be completed and signed by the student's physician. All requested information must be provided.
No other immunization reports, records, or forms will be accepted.
The third section "Physical Examination" must also be completed, signed and dated by your health care provider after the examination. All requested information must be completed. No other physical examination form will be accepted.
Any section of the form that is not complete, will be returned to the student for completion. A registration hold will be placed if not completed by the above deadlines.
Physical examination and medical history forms are mailed to all newly deposited students. To download the fall 2009-2010 form here (Adobe Acrobat .pdf).
To view a web clip explaining how to complete the physical examination form, see the video above.
On-Line Submission
Students who are 18 years of age or older can complete and submit the student section of physical examination on line. This information is sent directly to Student Health. Students must use their Canisius College GriffMail username and password to access the on-line form.
When completing the on-line form, remember to save all information after completing each area of questions. This allows you to log off and return later to finish without losing what has been entered.
Once the on-line is completed, you must verify completeness and submit it to Student Health.
The next step is to download the immunization and physical examination sections for your doctor to complete.
It is important to remember that without the immunizations and physical exam your health requirements are not complete.
To start the on-line medical history form, click here.
International Students
International students must use a special physical examination form designed specifically for them. This form is available in International Student Programs.
International students can not use the on line medical history option.
Physical Examination Services in Student Health
The Student Health Center offers physical examinations and immunizations needed for class attendance. To schedule an appointment for these services please call the Student Health Center at 888-2610. Students will be charged a fee for these services. Payment is required at the time of service. Physical examinations cost $100 in the Health Center.
Immunization rates in the Student Health Center are as follows:
Physical examinations and immunizations can also be obtained through county health departments.
Measles, Mumps, Rubella $57 Meninigitis $100 Tetanus/diptheria booster $40 PPD for TB screening $25
Important Points to Remember
Submit only the Canisius College physical examination form. No other forms are accepted.
The physical examination and medical history form must be completed, signed and dated by both the student and their health care provider in all the areas and sections requested on the form.
Forms must be signed by the student's parent or legal guardian, if the student is a minor at the time the form is completed.
Authorization for treatment must be signed by a parent or legal guardian for minors.
Forms must be written in English, neat and easy to read.
Forms that do not meet these conditions are deemed incomplete and will be return to the student, in the mail, at the student's permanent address, for completion.
Incomplete forms are deemed non compliant.
Make a copy of the form and store in a safe place for future reference if needed.
Student Health does charge for copying physical examination forms. To read about confidentiality and copying charges, click here.