Student Health Services
  Health Center Medical Record Form

Acrobat Reader is needed to download this form.  If you do not have Acrobat Reader download HERE

Click here to download Health Center Medical Record

PHYSICAL EXAMINATION (PART III - VI) MUST BE SUBMITTED ON THE UNIVERSITY FORM

FAXED COPIES OF THE MEDICAL RECORD FORM ARE NOT ACCEPTABLE

PLEASE MAKE A COPY OF MEDICAL FORM FOR YOUR RECORDS