Interim Health Clearance Form - New York University 2026

1. Click ‘Get Form’ to open the Interim Health Clearance Form in our editor.
2. Begin by filling in your personal details. Enter your name, date of birth, NYU N Number, phone number, and email address in the designated fields.
3. Review the authorization statement regarding health data release. Ensure you understand your responsibilities and check the box if applicable.
4. Sign and date the form at the bottom of the section for students/faculty. This confirms your agreement to the terms outlined.
5. Next, provide the required information for your health care provider. They will need to complete their section after performing an examination.
6. Ensure that your health care provider signs and dates their section, confirming your eligibility for clinical practice.
7. Once completed, save your form and distribute copies as instructed: one to the Office of Clinical Affairs and keep one for your records.

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