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Iowa City Community School District

Dedicated to excellence in education

Clinic Forms

Consent for Care & Release of Information (English)

Consent-and-ROI-English.pdf 187.33 KB (Last Modified on February 3, 2022)

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Consent for Care & Release of Information (Spanish)

Consent-and-ROI-Spanish.pdf 262.69 KB (Last Modified on February 3, 2022)

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Consent for Care & Release of Information (French)

Consent_formROI_in_FRENCH.pdf 420.93 KB (Last Modified on August 25, 2021)

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Consent for Care & Release of Information (Swahili)

FINAL.Consent-ROI-8.2018.Swahili.pdf 180.21 KB (Last Modified on August 25, 2021)

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Adult (18+) Consent for Care & Release of Information (English)

Adult_Consent_and_ROI_-_English.pdf 162.46 KB (Last Modified on August 25, 2021)

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Adult (18+) Consent for Care & Release of Information (Spanish)

Adult_Consent_and_ROI_-_Spanish.pdf 277.88 KB (Last Modified on August 25, 2021)

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Health History (English)

Medical_History_Form_-_English.pdf 314.85 KB (Last Modified on August 25, 2021)

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Health History (Spanish)

Medical_History_Form_-_Spanish.pdf 312.33 KB (Last Modified on February 3, 2022)

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Pre-Participation Sports Physical Exam Forms

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