Health History Form

Health History Form

Click on the link below to print out the Health History Form in PDF format.

PDF icon Health History Form (PDF 158 KB)

(Download free Adobe Acrobat Reader to view PDF document.)

Contact the Health Center if you need assistance in obtaining the Health History Form.


Office Hours:
Academic Year
Mon-Fri, 8:30 a.m. - 5:00 p.m.
Summer Hours
Mon-Fri, 8:00 a.m. - 4:00 p.m. (Triage only)

Student Health Center

LoGrasso Hall
State University of New York at Fredonia
Fredonia, NY 14063
(716) 673-3131 phone
(716) 673-4722 fax