Services - History and Physical Form

Print out a blank History and Physical Form available in PDF format. (This form cannot be filled out on-line.) You MUST complete the first (1st) page of this confidential record of your medical history and physical examination BEFORE you visit the Student Health Center. The second (2nd) page of the form is to be completed by your physician. For ATHLETIC physicals, the third (3rd) page MUST also be completed.