Get Physical Examination: Mandatory For All New Students

Completing the Physical Examination form is essential for all new students at Butler University. This guide provides clear and user-friendly instructions to help you fill out the form accurately and efficiently.

Follow the steps to successfully complete your Physical Examination form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your personal information in the designated fields, including your full name, date of birth, height, and weight. Ensure that all entries are accurate.
3. Record your blood pressure and pulse in the appropriate sections. This information is vital for the evaluation of your health status.
4. Complete the review of systems (ROS) section. Indicate 'Normal' or 'Abnormal' for each category, which includes HEENT, neck, lungs, heart, abdomen, skin, genitourinary, musculoskeletal, neurological, and any other relevant areas.
5. Provide evidence of immunity for required immunizations, including varicella, mumps, and any other relevant vaccinations. Include the quantitative titer results if your immunization series is not complete.
6. List any medical conditions, medications, and special dietary requirements you may have. This information helps ensure your health needs are met.
7. Document any known allergies and other special needs or pertinent information to assist with your health assessment.
8. Ensure the form is signed by a qualified health care provider (MD, PA-C, NP, DO) and include their printed or stamped name, address, phone number, and fax number.
9. Review all entered information for accuracy and completeness before submitting the form.
10. Save changes to the document, and download, print, or share the completed form as required to ensure your submission by the due date.

Complete your Physical Examination form online today to meet all university requirements!