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Interim Health Clearance Form - New York University 2026
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- Click ‘Get Form’ to open the Interim Health Clearance Form in our editor.
- 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.
- Review the authorization statement regarding health data release. Ensure you understand your responsibilities and check the box if applicable.
- Sign and date the form at the bottom of the section for students/faculty. This confirms your agreement to the terms outlined.
- Next, provide the required information for your health care provider. They will need to complete their section after performing an examination.
- Ensure that your health care provider signs and dates their section, confirming your eligibility for clinical practice.
- 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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