Health Center

Before Arrival Checklist

All forms are available at


_____ Read Immunization Policy & Instructions

_____ Complete and sign Health History Form

_____ Complete Immunization Documentation Form, signed by healthcare provider, or provide Health Department, Physician, or School record

_____ Return all forms (Health History Form, Immunization Documentation Form, and waiver (if applicable) to:


Esry Student Health Center
Missouri Western State University
4525 Downs Drive – Blum 203
St. Joseph, MO 64507-9987
Phone: (816) 271-4495
Fax: (816) 271-4498

PLEASE TURN IN BEFORE the following dates:

Fall Semester – August 1
Spring Semester – December 1
Summer Semester – April 1

Please return directly to Esry Student Health Center, DO NOT submit with other Admissions materials.

If you have a significant health problem, please contact Esry Student Health Center before coming to campus.