Get Medical Information And Release Form - The University Of Texas At ...

Filling out the Medical Information And Release Form is an important step in ensuring your health and safety while participating in activities organized by The University of Texas At Dallas. This guide provides clear and concise instructions to help you complete the form online.

Follow the steps to fill out the form effectively.

1. Click ‘Get Form’ button to obtain the Medical Information And Release Form and open it in the online editor.
2. Begin filling in your name clearly in the designated fields provided, separating your first name and last name.
3. Provide your complete address, including city, state, and zip code.
4. Enter your telephone number in the specified format, ensuring to include the area code.
5. Include your birthdate in the correct format, ensuring accuracy.
6. List emergency contact persons along with their names, relationships to you, and both daytime and nighttime phone numbers.
7. Populate the physician and dentist information with their names, addresses, and office contact numbers.
8. Detail any allergies you have in the appropriate section.
9. Indicate if you have health insurance, and provide the necessary insurance details including the company name and contact number.
10. List any medications you are currently taking, including dosages and purpose.
11. Record the date of your last Tetanus/Diphtheria inoculation along with your blood type.
12. Describe any special health needs or concerns in the provided space.
13. Read and sign the Emergency Medical Authorization section, confirming your consent and understanding of the information provided.
14. Save your changes and proceed to download, print, or share the form, as necessary.

Complete your Medical Information And Release Form online today to ensure your participation!