Les Roches Medical Form
Full name *
Your answer
Email *
Your answer
Student ID (found in your acceptance pack) *
Your answer
Program *
Intake *
Have you ever had or suffered from the below:
Chicken pox *
Rubella *
Mumps *
Measles *
Tuberculosis *
Hepatitis A/B/C *
Vaccination
Diphteria *
Wooping cough *
Poliomyelitis *
Tetanus *
Tuberculosis *
Allergies (to medicines, food or any other substances) *
Patient declaration *
Required
To Note
If you have selected 'yes' to any of the above or if you wish to discuss your situation in a confidential manner, you can contact the Nurses Team at nurse@lesroches.edu or at +41274859614.

Les Roches reserves the right to request additional information regarding your medical situation, including a medical certificate attesting your fitness to undertake studies

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