Exchange Student Medical Profile Form
Personal Information
Full Name
Date of Birth
Gender
Female
Male
Other
Nationality
Passport Number
Emergency Contact
Name
Relationship
Phone
Medical Information
Blood Type
A+
A-
B+
B-
AB+
AB-
O+
O-
Allergies (if any)
Current Medications
Chronic Medical Conditions
Immunizations (eg. MMR, Tetanus, COVID-19)
Primary Physician Name & Contact
Other Relevant Medical Information