Pre-Health Advising Intake Form
Please complete this form to help us understand your advising needs and schedule a follow-up meeting.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Academic Status
*
Please Select
High School Student
College Freshman
College Sophomore
College Junior
College Senior
Post-Baccalaureate
Other
Intended Health Profession
*
Please Select
Medicine (MD/DO)
Dentistry
Pharmacy
Nursing
Physician Assistant
Physical Therapy
Occupational Therapy
Veterinary Medicine
Other
What are your primary advising goals?
*
Course planning
Application preparation
Career exploration
Extracurricular planning
Other
Current Coursework or Status
Anticipated Application Timeline
*
Please Select
Within the next year
1-2 years
2+ years
Not sure
Have you met with a pre-health advisor before?
*
Yes
No
Preferred Meeting Format
*
In-person
Virtual (video call)
Phone call
No preference
Notes or Questions (non-sensitive only)
Submit
Should be Empty: