College Health Forms

Please call to schedule an appointment at our El Dorado or Andover locations. Forms and immunizations can be emailed to collegehealth@butlercc.edu

General Student Forms

• Release of Records to Health Services
• Release of Records from Health Services

Nursing Department Forms

• Entry Level Health Form
• Annual Physical Form
• Hepatitis B Waiver
• FAQs for Nursing, EMT, and AEMT
• COVID Exemption Form
• Influenza Declination Form
• Clinical Requirement Process for Exemption

Allied Health Forms

• CNA/CMA Physical
• EMT Physical
• Fire Science Physical