Step 4 - Health Questionnaire and Medical Clearance

You and your students need to complete Periodic Animal Contact Health Questionnaire (pdf). The last page, the Clearance Recommendation, will be completed by a physician.

• Complete the first part – the Periodic Animal Contact Health Questionnaire
• Take the Questionnaire/Clearance Recommendation to your personal physician.  You are responsible for any associated costs.  Students can make an appointment at the Student Health Center and the visit with a nurse should cost $20.
• If you or your students have not received a tetanus booster within the last 10 years, you will need to receive a booster.
• Once the last page has been completed, return it to Dr. Jeffrey Jasperse in the Natural Science Division.
  Pepperdine University
  24255 Pacific Coast Hwy
  Malibu, CA 90263-4321
  Phone: (310) 506-4949
  Fax: (310) 506-4785