Please note: this form should only be submitted if you have made your deposit.
The information provided on your medical form will assist Student Health in caring for you while you are attending D&E.
This online form has two parts:
- Please complete the form below as accurately as possible.
- Then, print a copy of the physician's section of the form to be completed by your family doctor and return the physician's section to: Office of Admission, 100 Campus Drive, Elkins, WV 26241.
You will need to schedule an appointment with your physician to complete the physical exam. Your doctor will be required to complete the physician's section of the medical form. If you have had a physical exam within the last 3 months you will not need to schedule another; but it will still be necessary for you and your physician to complete this form.