Click the button below to begin electronically signing the form. You may also download the Health History form to print, fill out, and send back to us. Forms should be emailed to firstname.lastname@example.org or mailed to the following address:
Dr. Bob Smith Health Center
P.O. Box 750195, Dallas, Texas 75275-0195
If you are under the age of 18, include your Parent/Guardian Name and Email address on the form. A Parent/Guardian is required to sign the form of any student under the age of 18. The Parent/Guardian will receive notification via the email provided to electronically sign the form. Please note: The form will not be submitted until after the Parent/Guardian signs the form.
All incoming students must comply with the following vaccination requirements. Attach official immunization record to the electronic Health History form or download the form and send a completed copy to your doctor for signature and stamp. Email signed forms to email@example.com.
1. Meningitis vaccine (Menactra, Menveo, or MCV4) administered within the past 5 years. Texas State Law requires a meningitis vaccine for new students under the age of 22. Students over the age of 22 are exempt from this requirement. Proof of vaccination (or booster shot within the last 5 years) must be submitted to the Dr.Bob Smith Health Center prior to registering for classes.
2. Two doses of the Measles, Mumps, and Rubella (MMR) vaccination
If you answer YES to any of the TB screening questions on the Health History form, the results of a TB Skin Test within the past 6 months is REQUIRED. Attach official TB Skin Test results to the electronic form or email to firstname.lastname@example.org.
Allow a minimum of seven (7) business days for delivery if mailed from a location within the United States and two (2) business days if electronically submitted or emailed. If possible please submit at least two (2) weeks prior to your orientation/registration. SMU is not responsible for forms not received due to mail misdirected or lost in transit. Incomplete or illegible submissions cannot be processed.
- For verification. You may check your My.SMU account after submitting your Health Form to verify receipt and completeness by going to: My.SMU Student Homepage > Health Center > Health History.
- If you have any questions please email us at email@example.com, please include your name and SMU ID number.
The Dr. Bob Smith Health Center may provide vaccinations or a TB Skin Test, please contact the health center at 214-768-2141 for more information.
Electronically Sign & Submit the Health History Form