Follow the steps to effectively complete the intake form online.

1. Press the ‘Get Form’ button to access and open the Prevea Health Student Intake Form - Observation Only in your preferred online document editor.
2. Begin by entering your name in the designated field labeled 'Student Name'. Follow this by providing the current date in the 'Date' field.
3. Fill in your complete address, including street, city, state, and zip code in the 'Address' section.
4. Input your phone number and email address in the corresponding fields to ensure clear communication.
5. Provide your date of birth in the specified area, ensuring the format is month, day, year.
6. Indicate the school and program you are currently attending in the 'School and Program Attending' section.
7. Specify the degree you are pursuing in the 'Degree Pursuing' field.
8. In the 'Department/Person you wish to be placed in/with' section, list the department or individual you prefer to observe.
9. State the role you wish to be paired with, such as MD, DO, PT, PA, NP, etc., in the designated field.
10. Indicate the dates you are available for observation in the 'Dates Available for Observation' section.
11. Specify your preferred geographic locations for observation experience in the provided space.
12. Ensure to gather and prepare to submit the necessary documentation, including the Student Observer Guidelines Form, Student Confidentiality Statement, Student Observer Health Form, TB Test results, and evidence of MMR, Varicella, and Influenza immunizations.
13. After completing all required fields, review your entries for accuracy. You can then save the changes, download, print, or share the form as needed.

Complete your forms online today for a seamless observation experience.