College Admission Physical Examination Form
Personal Information
Full Name
Date of Birth
Student ID/Registration No.
Gender
Address
Phone
Email
Medical History
Past or present illnesses, surgeries, or conditions
Allergies (medication, food, other)
Current Medications
Physical Examination
Height (cm)
Weight (kg)
Blood Pressure
Vision (L/R)
Hearing
System Review
Head
Chest
Abdomen
Skin
Extremities
Other Findings
Additional Comments
Physician Name
Phone
Signature
Examination Date