Get 3. Medical Form - Interexchange - Interexchange

Completing the 3. Medical Form is essential for ensuring your health information is known prior to participating in your program. This guide will walk you through each section of the form to help you provide the necessary details accurately. Please ensure you have all relevant information available when filling out the form online.

Follow the steps to complete the medical form effectively.

1. Press the ‘Get Form’ button to access the medical form and view it in your preferred online format.
2. Fill in your personal details, including your name, gender, address, city, state, home and work phone numbers, email address, date of birth, height, weight, and zip code.
3. Provide your blood pressure and resting pulse information in the designated fields.
4. Complete the emergency contact section, listing a primary contact and their relationship to you, along with their phone numbers for home, work, and cell. Also, list a secondary contact if the primary is unavailable.
5. Enter your medical insurance information, including the company name, policy number, and any applicable contact numbers.
6. In the allergies section, detail any allergies you have, specifying the type of allergy and any required medications.
7. List all medications you are currently taking in the medical history section, including prescription, over-the-counter, and natural medications, along with their frequency and known side effects.
8. Answer the health-related questions about conditions such as asthma, diabetes, high blood pressure, visual and hearing problems, pregnancy, and history of seizures or altitude problems. Provide explanations where required.
9. Specify any physical or mental restrictions that may affect your participation, or initial the acknowledgement if you have none.
10. Record the date of your most recent physical examination, along with your physician’s name and phone number, and include their signature if necessary.
11. Confirm your trip details by entering the trip name and dates, and append your signature and the date at the bottom of the form.
12. Once all sections are completed, you can save your changes, download, print, or share the completed form as needed.

Complete your medical form online today to ensure a smooth and safe experience on your trip.