Health History Form for Student Health Services





If you need help recovering your Student ID, please see this link: Retrieve Account Info

Health Services Requirements and Recommendations
Required - Measles (Rubeola) documenation is a state of Oregon law (details Certificate of Immunization)
Recommended - all immunizations are up to date (see www.cdc.gov/vaccines)
Recommended - up to date wellness exam/screening tests (check with your health care provider)
Recommended - please learn about your health insurance (as a beginning review the website)


Personal History

























If you have additional medications to report, please contact Concordia University's Director of Student Health Services at studenthealthservices@cu-portland.edu.












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Immunizations - Note: Please enter most recent dates of vaccination on the form
Measles/Mumps/Rubella (MMR) - 2 Doses Required. Please fill out the Certificate of Immunization Form found on the Concordia Health Services page.









Entering your name into the signature block above indicates that you certify that all information submitted is true and correct.

For questions about this form, please contact the Director of Student Health Services at studenthealthservices@cu-portland.edu

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