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UNC CAMPUS HEALTH SERVICES INTERIM PHYSICAL FORM Name (Last, First, MI.): Date of Birth: Preferred Name: Preferred Pronoun: PID: Date: Reason for Visit: Current Medications: Name the Medication Dosage
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How to fill out UNC Campus Health Services:

01
Visit the UNC Campus Health Services website or go to the campus health center in person.
02
Complete the necessary forms, which may include personal information, medical history, and insurance information.
03
Provide any additional documents or records requested, such as immunization records or previous medical records.
04
Schedule an appointment if needed or follow the instructions for walk-in services.
05
Arrive at the designated time for your appointment or walk-in visit.
06
Meet with a healthcare professional who will assess your needs and provide appropriate medical care or referrals.
07
Follow any post-appointment instructions, such as filling prescriptions, scheduling follow-up visits, or attending recommended screenings or treatments.

Who needs UNC Campus Health Services:

01
UNC students - Any student enrolled at UNC-Chapel Hill is eligible for services at UNC Campus Health. This includes undergraduate, graduate, professional, and distance education students.
02
UNC faculty and staff - Campus health services are also available to faculty and staff members of UNC-Chapel Hill.
03
Dependents of students, faculty, and staff - Some health services may extend to dependents of students, faculty, and staff members. It is recommended to check with UNC Campus Health Services for specific eligibility criteria and available services for dependents.
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UNC Campus Health Services is the primary healthcare provider for students at the University of North Carolina at Chapel Hill.
All students enrolled at UNC Chapel Hill are required to utilize Campus Health Services for their healthcare needs.
Students can fill out UNC Campus Health Services forms either online or in person at the health center.
The purpose of UNC Campus Health Services is to provide comprehensive healthcare services to students to support their academic success.
UNC Campus Health Services requires students to report their medical history, insurance information, and current health concerns.
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