Health Record Form
Required for all students. Please send your completed form and a copy of your immunization records to the LCU Admissions Office.
This form is required for students who answered YES to one or more of the TB Screening Questions on the Health Record Form (see link above). If this applies to you, please print this form and take it to your primary health care provider or your local health department for further assessment. This should take place no sooner than 6 months prior to beginning attendance at LCU. The form should be filled out & signed/dated by the health professional, then submitted to the LCU Admissions Office.
For any questions regarding either of, please contact the LCU Admissions Office at 806.720.7151 or the LCU Medical Clinic at 806.720.7482.
The forms may be submitted by:
- Mail (preferred):
LCU Admissions Office
5601 19th Street
Lubbock, TX 79407
- Fax: 806.720.7162
- Scan & email: firstname.lastname@example.org
Please retain a copy of these for your own records.