Preventative Care Form (Deadline 10/31/24) 2023-2024 Preventative Care Form
Use this form for medical visits, such as: dental exam and cleaning, eye exam, mammogram, flu shot, skin cancer screening, well-woman visit, colonoscopy, heart screening, etc.
Physician Wellness Screening Form (Deadline 10/31/24) 2023-2024 UCA Physician Wellness Screening Results Form
Use this form if you will have your primary care provider perform your biometric screening. Upload the completed form to HealthCheck360 or email it to support@healthcheck360.com or fax it to (563) 587-5720.
Reminder: Free biometric screenings are offered on the UCA campus at designated times each year. On-site screenings do not require use of this form.