Print and Submit the Medical Form    
The Medical History, including Immunization History must be completed, signed, and submitted to the campus nurse.

To submit the 2-page form:
  • The form can be faxed to 641-472-1145, or
  • The two pages may be scanned, saved in jpg format, and then emailed as an attached document to the campus nurse, or
  • The forms may also be mailed:
Campus Nurse
1000 N. 4th Mailroom #737
Fairfield, IA 52557

We very much prefer that the forms be sent to us in advance on your arrival on campus, but if necessary they may be submitted at registration.
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