Personal Health History FormEach new student is requested to submit a completed medical history form to the Health Center. It will be reviewed to determine how best to provide medical care for you when you seek treatment at the University Health Center. If you have not already done so, you will be requested to fill out the medical history form upon your first visit to the Health Center. All your medical records at the University Health Center, including background history, are kept in strict confidence.You probably received a printed version of the Personal Health History Form included in your new student mailings. If not, or if you prefer filling it out on-line, an on-line version is included here. You will still need to print out the form, sign and date it, and turn it in, but most students find it easier to fill most of it out on screen before printing. You will need Adobe Acrobat Reader to view and print this form.
Personal History Form - On-line Version (form can be printed and filled out by hand or may by filled out on-line and then printed on your computer. You must still submit it manually. Caution - data will not be saved. If you close the program and start again later, all data fields will be empty. |
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