Steps for completion of the pre-participation physical examination

1.    Prior to your visit to an Examining Physician, it is highly recommended that you:

a.    Print neatly on any areas required

b.    Do NOT sign name, date, or enter social security number until you are with the examining physician

c.    Review each document for proper and full completion prior to departing the physician’s office

d.    Ensure the physician understands the procedures for the Physical Examination Form, and that it is required to be mailed as soon as possible

Following the above recommendations will assist you, the physician, and Mesalands Community College with this process. 

2.    Each prospective student is required to take the four (4) Mesalands Community College Forms to the physician conducting the physical (obtain forms from Student Services):

a.    Pre-participation Physical Evaluation History Form

·   The student reads and completes the entire form.

·   The student provides this document to the examining physician.

b.    Authorization for Release of Information

·   The student must read, complete and sign the form.

·   Period of Enrollment: Enter the date of your physical exam and your expected graduation date.

c.    Pre-participation Physical Evaluation Physical Examination Form

·   The examining physician completes this entire form.

·   The examining physician does NOT return this form to Mesalands Community College. 

d.    Pre-participation Physical Evaluation Clearance

·   The physician will complete the entire form.

·   The physician then sends the form to Mesalands Community College to the address located at the bottom of the form.

3.    Should you or the examining physician have any questions, contact Student Services at (575) 461-4413, extension 100.