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Clark University Health Services UNDERGRADUATE PHYSICAL EXAMINATION FORM Name: Date of Birth: Gender: G Male Females Trans Does applicant have any past/current medical problems? G Yes G No If yes,
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Read the instructions on the form carefully before starting.
02
Gather all necessary documents and information, such as medical history and immunization records.
03
Provide accurate personal information, including your name, date of birth, and contact details.
04
Fill out each section of the form thoroughly and accurately.
05
Consult a healthcare professional if you have any doubts or questions while filling out the form.
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Submit the completed form to the designated authority or institution.
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Keep a copy of the filled-out form for your own records.

Who needs undergraduate physical examination form?

01
Undergraduate students who are enrolling in a college or university.
02
Students who intend to participate in sports or physical activities on campus.
03
International students who are applying for student visas or study permits.
04
Students who have a history of certain medical conditions or require special accommodations.
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Students who will be living on campus or in student housing.
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The undergraduate physical examination form is a document that collects information about a student's health and medical history.
All incoming undergraduate students are required to file the undergraduate physical examination form.
Students can fill out the form by providing accurate information about their medical history, current health status, and any required vaccinations or tests.
The purpose of the undergraduate physical examination form is to ensure that students are healthy and able to participate in academic activities.
Information such as medical history, current health status, vaccinations, and test results must be reported on the undergraduate physical examination form.
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