College Health Forms | Butler Community College
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Planned System Upgrades

Due to planned system upgrades, Banner will be unavailable starting Friday night and will last until Sunday night.

College Health Forms

Health Services provides physicals and immunizations at reduced rates.
Pleasse 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 

Clincial Requirement Process for Exemption

 

Allied Health Forms

CNA/CMA Physical

EMT Physical

Fire Science Physical