Health Record Form
Required for all students. Please fill out the form at your be.LCU.edu profile.
This form is ONLY 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 a licensed health professional, and then submitted to your admissions advisor.
For any questions regarding either of these forms, please call or email the LCU Admissions Office at 806.720.7151 or admissions@LCU.edu, or the LCU Medical Clinic at 806.720.7482 or healthforms@LCU.edu.
Please retain a copy of these forms for your records.
The forms may be submitted by:
United Supermarkets Pharmacies
U.S. Center for Disease Control
American Academy of Family Physicians - providing general medical information for patients and their families
City of Lubbock Health Department