CIEE Physician Medical Report Form - Fill Out and Use This PDF

What Is the CIEE Physician Medical Report Form?

The CIEE Physician Medical Report Form is a comprehensive health evaluation required for all applicants to CIEE International Study Programs. CIEE support staff and program coordinators use the completed PDF form to review each participant's medical history and confirm medical fitness before the program begins. The form also helps CIEE identify any health-related accommodations that participants may need during the program.

Who Needs to Complete This Form

All students applying to CIEE International Study Programs are required to submit the Physician Medical Report Form. This includes participants in high school exchange programs, college study abroad programs, gap year programs, and professional internship programs operating in the United States and internationally. The application process is not complete until CIEE receives and approves the medical report. Early submission is strongly recommended to avoid delays in program placement and to give CIEE support staff time to review the information.

What the Physician Reviews and Documents

A licensed physician must conduct a full physical examination and complete the physician section of the PDF form. The evaluation covers the applicant's general health status, vital signs, medical history, current medications, and immunization records. The physician must document any physical or psychological conditions that are currently being treated, along with any conditions that could affect the applicant's ability to participate in the international study program. If additional medical information is needed, the physician may attach a separate sheet to the form. The examination must take place within four months of the CIEE program start date, and the completing physician must not be a parent or legal guardian of the applicant.

Submission and Review Process

Once the physician signs and dates the completed form, submit the PDF to your CIEE program coordinator by the specified deadline. CIEE support staff review each submission and contact participants if additional information is needed. Keep a copy of the completed medical report for your personal records. For related health documentation, see our EAEDC Medical Report Form and Student Health Clearance Certificate.