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The Health Services department maintains students Health Records, assists students and staff who are not feeling well, and offers information and help with nutrition, exercise, and any other health-related issues.  Students may also refer himself/ herself or a friend with a concern over substance use.


Health Forms


Please return forms by:

  • scanning and emailing to Nurse Marty Harvey (harvey@cheverus.org),
  • faxing to 207-828-0207 (this fax is in a private location),
  • or delivering to the Loyola receptionist in a sealed envelope or to the Health Services Office in Loyola. 

The Health Services Office will send an email confirmation upon receipt of all health forms.

Please see below to find out which forms you and your student(s) need to submit.



For Parents/Guardians to Complete:
For Doctor/PCP to Complete:


The doctor/PCP completes both forms and includes the most up-to-date immunization record based on the most recent exam. These documents must be completed for the student to be eligible to participate in school events (including athletic practices). 


For Parents/Guardians to Complete:
For Doctor/PCP to Complete:


The doctor/PCP completes both forms and includes the most up-to-date immunization record based on the most recent exam. These documents must be completed for the student to be eligible to participate in school events (including athletic practices). 

Immunization Notes: Incoming Juniors must have documentation of two Menactra Vaccines for Meningitis. Any student who has been out the country for more than two consecutive months must provide a negative PPD test.


The State of Maine requires the following immunizations:
  • 5  Doses of any DPT (diphtheria, tetanus, pertussis) containing vaccine, or 4 if the fourth dose is given on or after the 4th birthday
  • 1 Tdap booster for 7th-grade students
  • 4  Doses of OPV, IPV (Polio), or 3 if the third dose is given on or after the 4th birthday
  • 2 Doses of MMR (measles, mumps, rubella), #1 after 1 year of age, #2 at least one month after #1
  • 1 Dose of Varicella (chickenpox) for those under age 13, 2 doses given 4-8 weeks apart for age 13+, or documentation by a health care provider that the student has had the disease, or has an immune blood test
  • Negative PPD -- Any student that has been out of the United States for a duration of 6 months or more, must provide proof of a negative PPD test and  a negative chest Xray is mandatory if skin assessment indicates a positive result for TB --OR --  proof of immunization for TB
  • Eye Exam --   Proof of an eye exam before entering the 9th grade
  • MCV4 – Quadrivalent meningococcal conjugate vaccine:  Effective start of school year 2018. One dose of MCV4 is required for children entering the 7th grade.  Any child entering the 12th grade is required to receive two doses of MCV4.  Second dose on or after the 16th birthday – at least eight weeks after the first dose.  If the first dose is administered at age 16 or older, only one dose is required.  

Parents and guardians may request an immunization waiver for sincere religious beliefs, philosophical reasons, or medical reasons. 


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