Health Record Form
Required for all students. Please complete the form and send to the LCU Medical Clinic along with your immunization records.
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 Medical Clinic.
For any questions regarding these forms, please contact the LCU Medical Clinic at 806-720-7482.
The forms may be submitted by:
- Mail (preferred):
LCU Medical Clinic
5601 19th Street
Lubbock, TX 79407
- Fax: 806-720-7483
- Scan & email: firstname.lastname@example.org
Please retain a copy of these for your own records.