Indiana University Health Center - Student Health History Questionnaire

Patient Portal Login

Online Confidential Health History Questionnaire

Please complete the Health History Questionnaire online. All your information is protected with the latest security methods and is transmitted to our secure computers within the Health Center. The more accurate information you give us, the better health care we will be able to provide to you.

To access the Health History Questionnaire, you must first read the Health Center’s Notice of Privacy Practices provided below. You must be a registered student. Once you have read the Notice, please check the box provided prior to proceeding to the Health History Questionnaire. You will not be able to access the Questionnaire until you have done so. If you have just registered you may not be able to log on to the questionnaire right away, as it may take 48 hours for the ID to be available to our system. If you experience further problems please contact our Help Desk at (812)856-5475.

HIPAA Notice of Privacy Practices
The Health Insurance Portability & Accountability Act (HIPAA) requires that all new patients receive the Health Center’s Notice of Privacy Practices . The Notice outlines how your health information will be used and disclosed at the Health Center.

I am acknowledging my receipt of the Health Center’s Notice of Privacy Practices. If you have questions regarding the content of the Notice, please contact the Health Center’s HIPAA Compliance Officer at (812) 855-6511.

Be sure to close your web browser after completing the Questionnaire to keep your information secure and confidential. Do not leave the window open.