Coe nursing students

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 we must have an immunization record on file for each student before the first day of classes.

For incoming students, the forms must be returned to Health Services by July 1. This can be done through 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

Download the Health Services Forms

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

Athletic Forms

Athletic Forms

If you are a Coe athlete, you also must submit your physical to the Coe athletic department per NCAA guidelines. Click here for instructions.

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).
  • Dates of Diphtheria/Pertussis/Tetanus (DPT) series and a Tetanus booster if 10 years have elapsed since the last Tetanus immunization.
  • Dates of Polio series.

RECOMMENDED Immunizations are:

  • The Hepatitis B series is highly recommended for all students. It is required for nursing and athletic training majors.
  • Date of chicken pox disease or date of the Varicella vaccination(s).
  • Meningitis vaccine is highly recommended. The state of Iowa requires incoming students who will be residing in a campus residence hall receive information regarding the risks associated with Meningococcal disease. The student residing in campus housing must affirm whether he/she has 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.