Get Medical Form - Xavier University - Xavier

Filling out the Medical Form for Xavier University is an essential step for individuals participating in on- and off-campus activities. This guide provides detailed instructions to ensure that all necessary information is accurately filled out for effective emergency medical care.

Follow the steps to successfully complete the medical form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal details in the general information section. Include your last name, first name, middle name, date of birth, and choose your gender.
3. Provide your permanent mailing address, including street, city, state, and zip code. Also, include your telephone number.
4. In the health problems section, list any ongoing health issues you are currently experiencing.
5. Document any drug allergies by listing them and providing a brief description of the reaction experienced.
6. Record any medications you regularly take, including both prescription and over-the-counter drugs.
7. Indicate any past medical history by checking the related boxes for conditions you have experienced, such as asthma, heart problems, or surgeries.
8. Fill out the family medical history section by noting any relevant conditions that have affected family members.
9. Complete the emergency contact information by filling in details for your first and second emergency contacts, including their names, relationships, addresses, and telephone numbers.
10. Review the certificate of medical insurance coverage section. Ensure to certify your insurance status by providing the necessary details and signing where indicated.
11. Attach a copy of your insurance card, front and back, as required.
12. After reviewing all the filled sections for accuracy, save your changes. You can then download, print, or share the form as necessary.

Complete your documents online today to ensure all necessary information is accurately submitted.