The following forms are available on-line as well as in the Campus Health office. If you have questions, please call 319-398-5588.

***Health Science Physical Packets: See Health Program Requirements Link***

The forms below are singles of what is included in the packet at the above link.

• Allergy Injection Policy / Form - Campus Health will administer allergy injections for any student or employee with a physician's order. 
• Blood and Body Fluid Exposure Risk Assessment Form - Necessary for any student who has a BBP exposure incident while in clinics. Be sure to fill out form and take to St. Lukes Workwell or Emergency Room.
• First Aid Kit Re-Order Form - Departments needing first aid supplies may fill out this form and send it to Campus Health.
• Health Science Physical Form - Students in Health Science programs must have a physical within one year of starting their program.  This form may be printed and taken to the physician when an appointment is scheduled.  Please see the Health Program Requirements link at the right for other requirements.
• Kirkwood Illness and Injury Report Form - Necessary for all students, staff, faculty, or visitors who experience an injury while on campus...please see Campus Health for details.
• Latex Allergy Accommodation Form - Students who have a latex allergy must see Campus Health for appropriate education prior to participating in lab and clinic.  See Latex Allergy link at the right for further information regarding latex.
• Privacy Statement - Students in Health Science programs must read, sign, and turn this form in with their Physical Form and immunization record.
• Release of Information Form - Students who need Campus Health records sent to another agency.
• TB Questionnaire - Students who have had a positive TB in the past must fill this form out once every year.