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UCSB Student Health Service Confidential Health History PATIENT NAME PERM# Birthplace: Ethnic Origin: Major Course of Study: IN AN EMERGENCY WHO SHOULD WE NOTIFY? NAME: Cell Phone #: Are you currently
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How to fill out UCSB Student Health Service:

01
Visit the UCSB Student Health Service website or go to their office on campus to obtain the necessary forms.
02
Fill out personal information such as name, student ID number, contact information, and insurance details.
03
Provide a detailed medical history including any pre-existing conditions, allergies, and medications.
04
Indicate any specific concerns or reasons for seeking medical attention, such as ongoing health issues or recent injuries.
05
If you have insurance coverage, provide the necessary information and make sure to attach a copy of your insurance card.
06
If you do not have insurance, inquire about the options available for accessing healthcare services.
07
Submit the completed forms either by mail, in person, or online through the designated portal.

Who needs UCSB Student Health Service:

01
All registered UCSB students have access to the Student Health Service and can benefit from the medical services offered.
02
Students who require routine check-ups or physical examinations for class requirements or personal well-being can utilize the services provided.
03
Individuals who have pre-existing conditions or chronic illnesses that require regular medical attention can benefit from the comprehensive care provided by UCSB Student Health Service.
04
Students who need immunization records or vaccinations can visit the health service to ensure they are up to date.
05
Individuals experiencing acute illnesses, injuries, or mental health concerns can seek medical attention from the skilled healthcare professionals at UCSB Student Health Service.
06
Students who need specialized services, such as sexual health consultations or counseling, can access these services through the Student Health Service.
07
Individuals who are in need of referrals to outside medical specialists can consult with the healthcare providers at UCSB Student Health Service for appropriate recommendations.
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UCSB Student Health Service provides medical, mental health, and wellness services to enrolled students.
All enrolled UCSB students are required to utilize the student health service.
Students can fill out the necessary forms and schedule appointments through the Student Health online portal or by visiting the Student Health Center in person.
The purpose of UCSB Student Health Service is to provide comprehensive healthcare services to support the overall well-being of students.
Students must report their medical history, insurance information, and any current health concerns or symptoms.
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