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Student health history form

student health history form

Looking to streamline your student health data gathering process? This comprehensive Student Health History Form could be your solution. Ideal for schools, colleges, and other educational institutions, it collects essential health details about students. It can assist health services at your institution in providing tailored care and handling emergency situations effectively. Plus, it's a great way to ensure you're meeting public health requirements. So, get ready to say goodbye to piles of paperwork and hello to organized, easily accessible information.

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Questions to include on your Student health history form

1. Personal Information

This basic information is essential for identification and communication purposes.

  • What is your full name?
  • What is your date of birth?
  • What is your gender? (Male, Female, Other, Prefer not to say)
  • What is your contact number?
  • What is your email address?

2. Educational Information

This information will help the institution gauge the educational background of the student.

  • What is your current grade level?
  • Name of the previous school/college attended
  • What was your major in previous school/college?

3. Health History

This section is crucial to understand the student's past medical history, which can assist in providing appropriate health care services if required.

  • Do you have any known allergies? (Yes, No)
  • If yes, please specify.
  • Have you ever undergone any surgeries? (Yes, No)
  • If yes, please specify the type and date of surgery.
  • Have you had any serious illnesses in the past? (Yes, No)
  • If yes, please specify.

Knowing the student's past medical history is crucial as it can help in case of emergencies or when providing any health-related services.

4. Current Health Status

This information will provide a snapshot of the student's current health situation.

  • Do you have any ongoing medical conditions? (Yes, No)
  • If yes, please specify.
  • Are you currently taking any medication? (Yes, No)
  • If yes, please specify.
  • Do you wear glasses or contact lenses? (Yes, No)

5. Immunization Records

Schools and colleges often require immunization records to protect the health of all students.

  • Have you been vaccinated against measles, mumps, and rubella (MMR)? (Yes, No)
  • Have you been vaccinated against Hepatitis B? (Yes, No)
  • Have you been vaccinated against Tetanus-Diphtheria-Pertussis (Tdap)? (Yes, No)
  • Have you been vaccinated against Meningococcal meningitis? (Yes, No)

Understanding a student's immunization record is important to ensure the safety of all students and to comply with public health requirements.

6. Emergency Contact

In case of medical emergencies, it's important to have contact information for the student's primary emergency contact.

  • What is the full name of your emergency contact?
  • What is the relationship of this person to you?
  • What is their contact number?
  • What is their email address?

The inclusion of an emergency contact is necessary as it allows the school or college to contact this person in case of any medical emergencies involving the student.

Things to consider

  1. Privacy and Consent - You must ensure that the data collected is confidential and used only for the stated purpose. Furthermore, explicit consent should be obtained from the user before data collection. Consider incorporating a checkbox where the user can agree to these conditions.
  2. User-Friendly Design - Make sure the form is easy to navigate. Group related questions together, use clear and concise language, and make sure the form isn't too long to prevent the user from feeling overwhelmed.
  3. Instructions and Help Texts - Include instructions or help text for complex questions. This will guide the user through the form and ensure they understand what's being asked.
  4. Validation and Error Messages - Use field validation to ensure that the data entered is in the correct format. Include clear error messages to guide users in correcting their input.
  5. Accessibility - Ensure that your form is accessible to people with disabilities. This could include providing alternative text for images and making sure the form can be navigated using only a keyboard.
  6. Mobile Compatibility - Given the high usage of mobile devices, make sure your form is mobile-friendly. This means it should resize and function properly on smaller screens.
  7. Save and Resume Later Feature - If your form is lengthy, consider incorporating a 'save and resume later' feature. This allows users to complete the form at their own pace without losing their progress.

How to create your Student health history form

Now that you know what questions you should include, it's time to build your form!

The only problem is that traditional forms tools are inefficient.

People will forget to fill out your form. They'll get stuck halfway and not be able to finish it. Or they'll send you the wrong stuff. You end up wasting hours chasing people down over email. 

That's why you should give Content Snare a try. 

Content Snare is packed with advanced features that will have you hours:

  • Automatic reminders - Remind people to complete their form with fully customizable reminders.
  • Reject incorrect information - If a single question is filled out incorrectly, ask your client to re-do just that one item.
  • Autosaving - No progress gets lost. People can fill out forms in multiple sittings.
  • Comments and questions - If the person filling the form gets stuck, they can ask a question without having to email you.

Give it a go by signing up for your free 14-day trial

Get the information you need without chasing people

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