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Print and Submit the Medical Form

The Medical History, including Immunization History form must be printed out, 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 of your arrival on campus, but if necessary they may be submitted at registration.

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