HS-HealthCenterForm-11x1716.indd 2026

1. Click ‘Get Form’ to open the HS-HealthCenterForm-11x1716.indd in the editor.
2. Begin by filling out your personal information on page 1, including your last name, first name, middle initial, home address, date of birth, and gender. Ensure all fields marked with an asterisk (*) are completed.
3. Proceed to the Family History section. Indicate any medical conditions present in your family and provide details as necessary.
4. In the Personal History section, answer all questions regarding your health history. Use the space provided to elaborate on any 'Yes' responses for clarity.
5. Complete the Physician’s Report section by having your healthcare provider fill in their details and comments based on your medical evaluation.
6. Fill out the Immunization Policy section carefully, ensuring that all required vaccinations are documented accurately.
7. If you are a minor, complete the Consent for Treatment section with a parent or guardian's signature.
8. Finally, provide your insurance information at the end of the form. Make sure to double-check all entries before saving.

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