Primary Care in Rochester and Kasson

Health Forms

Below are frequently requested health forms. Some may require completion by your primary care clinician. To request assistance with the completion of forms for you or your dependent, contact your clinician's office.

Department of Transportation

• DOT Medical Examination Report (MER) Form, MCSA-5875.
• Other DOT medical examination forms.

Head Start

• Application.
• Well Child Exam.
• Dental Exam.

Rochester Public Schools

Health forms includes:

• School Health Information Form.
• Consent to Release Private Data.
• Food Intolerances/Allergies.
• Anaphylaxis Emergency Care Plan.
• Special Diet Statement.
• Authorization for Administration of Medication.

Sports

• Minnesota State High School League Physical Exam Form (multiple languages available).
  
  • Annual Sports Health Questionnaire.
  • Physician's Approval to Resume Participation in Interscholastic Activities.
• Iowa Athletic Pre-participation Physical Examination Form.