Physical Therapy - Texas Woman's University - twu 2025

1. Click ‘Get Form’ to open the Physical Therapy Immunization Record in the editor.
2. Begin by entering your personal information, including your Name, SSN, Date of Birth, Email Address, and Phone Numbers. Ensure accuracy as this information is crucial for your records.
3. Fill in your Current Address details: Address, City/State, and Zip Code. This helps the university contact you if needed.
4. Indicate your Sex (Male/Female) clearly. This is a required field for compliance.
5. Provide proof of immunizations by filling in the required dates for MMR, Tetanus/Diphtheria Booster, TB Screening, Hepatitis B Vaccine, and Varicella Vaccine. Attach any necessary lab reports or documentation as specified.
6. Ensure that a healthcare provider signs the form or attaches signed copies of relevant documents. This step is essential for validation.
7. Finally, sign and date the form yourself to certify that all provided information is accurate before submitting it via mail or fax to the Immunization Program.

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