View & Download Health Forms Below:

Health forms can be submitted by email to nurse@msjnet.edu , faxed to 410-646-6220 or mailed to: Mount Saint Joseph High School, Attention: Mrs. Bezirdjian, School Nurse, 4403 Frederick Avenue, Baltimore, MD, 21229.

Please note Mrs. Bezirdjian will be out of her office from June 10, 2017 until August 21, 2017. Please email health forms to mconnor@msjnet.edu during the summer months.


Health forms:
Student Physical- download form here.
  • All freshmen and transfer students are required to submit a summer physical to the nurse by August 22, 2017. Physicals need to be done after May 22, 2017 for new students only. Students that enroll later in the school year must provide the nurse with a current physical and immunization record on their first day of school. We do not require yearly physicals for returning students at this time unless they play a sport.
  • Any student trying out for a school sport or playing a school sport must have a current physical on file with the nurse that does not expire while playing the sport.
  • Physicals are valid for one calendar year from the date of the examination
Immunization Form- download form here.
  • Maryland Department of Health and Mental Hygiene Immunization Certificate is also required of all new students, this includes all freshmen and transfer students
  • The form needs to be current and comply with the State of Maryland immunization regulations.
Consent for Over-the-Counter (OTC) Medication- download form here.
  • This form is required if you want your son to receive any over-the-counter medicine while in school.
  • The form needs be renewed every year and must be signed by a health care provider as well as the parent to be valid. The school nurse can’t dispense medicine without this form.
Physician Instructions for Prescribing Medication in School- download form here.
  • This form is mandatory for any student that will need prescription medicine during the school day.
Post Concussion Return to School Recommendations- download form here.
  • This form is to be completed by a health care provider following a concussion diagnosis.
  • The form must be returned to the nurse on the student’s first day back to school.