Health Forms

The Student Health Packet

The student health packet is crucial for the nurse to be able to provide individual services to each student.

In addition, medical personnel cannot make a valid diagnosis without proper knowledge of a student's medical history. 

Every student attending Doane College will need to submit the forms listed below:

• Doane College Student Health Requirements Checklist
• Student Health Packet
• Meningococcal Vaccination Waiver
• Parental Consent & Authorization
• Updated Immunization Record for Registration
• Medical History Report Form

Permission to Release Records

If you need your medical records released to another institution or facility, please fill out and return the Authorization for Release of Medical Information form. 

Questions or Contacts

If you have additional questions or concerns about the Medical History Report form or the Student Health packet, please contact our Director of Health and Wellness,
Kelly Jirovec:

work: 402.826.8265
home: 402.826.3541
e-mail: kelly.jirovec@doane.edu