Coe nursing students
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  4. Health Services
  5. Health Forms

Health Forms

All incoming students need to have a college entrance physical and complete the Student Health Evaluation Forms before beginning classes at Coe.

Per Iowa law, all students are required to have an immunization record on file with Health Services prior to the first day of classes. Class registration for subsequent semesters will be held if an immunization record is not submitted.

For incoming students, the forms must be completed by August 1. This can be done through the New Student Forms Portal, or via mail (1220 First Ave. NE, Cedar Rapids, IA 52402), email (o-healthservices@coe.edu) or fax (319.399.8269), or by bringing the forms to the clinic. It is recommended that you retain a copy of your health forms for your own records.

Mandatory Health Forms

Mandatory Health Forms

Login to complete the required health forms

  • Demographics and Insurance Form
  • Medical History
  • Physical Examination Form (completed by a medical provider)
  • Tuberculosis (TB) Screening Form
  • Proof of Immunizations

Student Athlete Medical Forms

Prior to participating on an athletic team at Coe College, student athletes must provide Athletic Training Services with medical information such as personal information, emergency contacts, medical history, medical alerts, health insurance and a copy of a physical examination with clearance to participate in intercollegiate athletics.

To expedite this process, Athletic Training Services utilizes online data entry via SportsWare, an online medical record system, where student athletes will need to enter their information.

Additionally, there are required forms for student athletes to review, complete and electronically sign. These forms are required annually and must be completed by August 1. The items below include:

  • SportsWare Online Instructions: SportsWare Video Tutorial
  • Recommended Athletic Physical Examination form — NCAA requires a physical examination for first-year and transfer students that has been conducted within the last six months of starting college.
  •  Under 18 year old release — to be completed if a student is under 18 at the time of completing the forms.
  • ADD/ADHD Information — If the student had been diagnosed with ADD or ADHD these forms need to be completed and submitted to athletic training services.

Questions and inquiries about athletic physicals should be directed to the athletic department (o-athletics@coe.edu).

A complete medical record includes:

Physical form

  • The physical must be completed within one year prior to attending Coe. Students who plan to participate in athletics at Coe, including cheerleading, need to submit a physical done within six months prior to attending Coe as a requirement of the NCAA.
  • International students will be given a Tuberculosis test after arriving at Coe before attending their first class.

Immunization Verification

  • Please fill in the dates on the appropriate form and have your health care provider verify with a signature.
  • A copy of your immunization record is acceptable, but the immunization form must be completed to make processing your records easier.
  • It is best to have immunizations updated with your primary medical provider before entering college.

REQUIRED Immunizations are:

  • Two doses of Measles (Rubeola), Mumps and Rubella, or two MMR (Measles, Mumps, Rubella) vaccines after 15 months of age (shot series are usually at 15 months and 5 years of age).
  • Diphtheria/Pertussis/Tetanus (DPT) series and a Tetanus booster if 10 years have elapsed since the last Tetanus immunization.
  • Polio series.

RECOMMENDED Immunizations are:

  • The Hepatitis B series is highly recommended for all students. It is required for nursing majors.
  • Proof of chickenpox disease or date of the Varicella vaccination(s).
  • COVID-19 vaccination (series)
  • Meningitis vaccine is highly recommended. The state of Iowa requires that incoming students who will be residing in a campus residence hall receive information regarding the risks associated with Meningococcal disease. The student who resides in campus housing must affirm whether they have received the vaccine against Meningococcal disease and must provide the date of the vaccination, if any. A waiver must be signed if the student elects not to receive the Meningitis vaccination. For more information about Meningococcal disease and immunization, visit:

Medical Health History and Insurance Information (2 pages)

  • It is best to fill out the information honestly and accurately to obtain the best health care through Health Services when attending Coe College.
  • All information is held confidential and not released without the written consent of the student.
  • Insurance information is used in the event the student needs medical care beyond the scope and practice of the nurse practitioner in the Health Services Office; or if the student would need X-rays, laboratory work, referrals for specialty care or prescription medication.