Fill out your name, blugold id number, and the sport(s) you will be participating in. You can then answer all applicable questions below. After you've completed the form, print out the page and bring the print out to your appointment.
Student Health Service • Crest Wellness Center 150 • University of Wisconsin-Eau Claire • Eau Claire WI 54702-4004
Phone: 715-836-5360 Questions/Comments: email@example.com Updated: November 10, 2011