SCHOOL MEDICAL FORM SCHOOL MEDICAL FORM Please enable JavaScript in your browser to complete this form. – Step 1 of 3NAME OF STUDENT *EMERGENCY TEL. NUMMBER *EMAIL ADDRESS *DATE OF BIRTH *NATIONALITY *CONTACT TO REACH IF ANY HEALTH-RELATED EMERGENCYNAME OF THE PERSON *HIS/HER PHONE NUMBER *YOUR RELATIONSHIP WITH THE PERSON *NextMEDICAL EXAMINATIONa. CONTAGIOUS DISEASES *YESNOb. ALLERGIC DISEASES *YESNOc. METABOLIC DISEASES *YESNOd. CARDIOVASCULAR DISEASES *YESNOe. DISEASES OF THE NERVOUS SYSTEM *YESNOf. DISEASES OF THE DIGESTIVE SYSTEM *YESNOg. DISEASES OF THE RESPIRATORY TRACT *YESNONexth. HEAMATOLOGICAL DISEASES *YESNOi. DISEASES OF THE MUSCLES/BONES *YESNOj. OTHER DISEASE *YESNOk. SURGERY *YESNOl. ACCIDENTS *YESNOTODAY'S DATE *Submit
