College Physical Examination Form printable pdf download

College Physical Examination Form

CLINTON COLLEGE

PHYSICAL EXAMINATION FORM

Name __________________________________________ Date of Birth _______________

Age ______________ Gender ___F ____M

Date of Exam _____________________

Height __________

Weight ___________

BP __________

Pulse ____________

Vision ______________

L ___________

B __________________

Color Vision: Normal __________________

Red Green Deficiency ____________

NORMAL

ABNORMAL

REMARKS

HEAD & NECK

EYES

EARS

NOSE

MOUTH & THROAT

TEETH & GUMS

THYROID

CHEST & LUNGS

BREASTS

HEART

ABDOMEN

UPPER EXTREMITIES

LOWER EXTREMITIES

NEUROLOGIC

CERVICAL SPINE

LUMBER SPINE

SKIN

POSTURE

ALIGNMENT

MOBILITY

SUMMARY OF FINDINGS

_____________________________________________________________________________________

RECOMMENDATIONS

_____________________________________________________________________________________

SIGNATURE OF MEDICAL PROFESSIONAL

________________________________________________

College Physical Examination Form