Health Form Checklist

This checklist is provided to help aid you in completion of your health requirements. Before submitting your forms, please review the items below for completion to ensure you have met all of Health Center requirements to attend the University of Evansville.

All required sections of the Physical Assessment Form, including physical examination, are complete.
*Physician's signature required.

Immunizations are up to date and compliant according to Indiana State and university guidelines.

  • MMR 1
  • MMR 2
  • Tdap
  • TB skin test
  • Meningococcal

The physical assessment and immunization records have been mailed, faxed or turned in to the Health Center before the published deadline.

Thank you for your diligent attention to the required details. We look forward to seeing you in the fall! If you have any questions, please don’t hesitate to contact us at 812488-2033 or by email at

Office Phone:

Office Email:

Office Location:
Sampson Hall, 1800 Lincoln Ave, Evansville, IN, 47722