Forms

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For ND Athletes – 2013-2014:
The following forms are to be filled out by all Notre Dame Athletes and returned to University Health Services prior to their physical exam.

• Athlete Medical History Questionnaire
• Athlete Nutrition Questionnaire
• Athlete Pre-participation Questionnaire
• Participation Physical Evaluation-Returnees only
• Athlete’s Medical Information Release Form
  Note! Female athletes should also complete the following form:
• Female Athlete Screening Form

Insurance Forms:
For the 2013-2014 academic year, all forms will be online with the School Sponsored Insurance Plan Provider
ON CALL – Worldwide Medical Information and Assistance

Others:

• Allergy Service Survey
• Authorization Form for Consent for Treatment of a Minor
• Consent to Acquire Information from Medical Record to release to UHS
• Medical History and Physical report
• Online Student Health
  Please Note! If you are having problems accessing the Online Student Health module, contact Connie Morrow at 574-631-1882 or cmorrow@nd.edu
• Information and forms for students on allergy immunotherapy
• Instructions for using the New Online Student Health
• Medical Information Release Form
• Meningitis Information Signature Form
  (To submit signature acknowledging receipt of Meningitis information)
• Patient Satisfaction Survey
• Post Travel Survey
• Prescribed Stimulant Medication Form
• Refusal of care against medical advice form
• Travel Service Survey