1. Prior to the student’s physical exam, it is highly recommended that the student: 

• Do NOT sign name, date, or enter social security number prior to the physical exam.
• Review each document for proper and full completion before departing the physician’s office.
• Ensure the physician understands the procedures for the Physical Examination Form, and that the form must be mailed as soon as possible.

The applicant is required to present the four forms (below) to the physician conducting the physical:

Pre-participation Physical Evaluation History Form

• The student reads and completes the entire form.
• The student provides this document to the examining physician.

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.

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.

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.