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Dorm Medical Information Form Mobile App

The Dorm Medical Information Form mobile app documents students living in dormitories and their medical conditions, medications, allergic reactions and vaccinations. This app can easily be customized to your universities standards.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Dorm Medical Information Form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Name

  • Ico textbox

    Home Address

  • Ico integer

    City

  • Ico textbox

    State

  • Ico integer

    Zip

  • Ico textbox

    SS#

  • Ico textbox

    Student's Phone

  • Ico statictext

    IN CASE OF EMERGENCY CONTACT

  • Ico textbox

    Name

  • Ico textbox

    Address

  • Ico textbox

    City

  • Ico textbox

    State

  • Ico integer

    Zip

  • Ico textbox

    Phone

  • Ico multiline

    MEDICAL CONDITIONS THAT STAFF SHOULD BE MADE AWARE OF

  • Ico multiline

    Medications

  • Ico multiline

    Allergic reactions to

  • Ico statictext

    MUMPS & MEASLES

  • Ico checkbox

    Have you had at least one MMR vaccination?

  • Ico checkbox

    Have you had the measles?

  • Ico statictext

    Please provide a copy of your vaccination records.

  • Ico camera

    Vaccination Record Sheet

  • Ico statictext

    MENINGITIS: We Recommends that all students living in the dorm have a meningitis vaccination.

  • Ico checkbox

    Have you had a meningitis vaccination?

  • Ico statictext

    If YES, a copy of your meningitis vaccination record must be on file

  • Ico statictext

    If NO, read and sign the following.

  • Ico signature

    I understand that meningitis is an infection that causes inflammation of the brain and spinal cor...

  • ...and More!

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