Student Health History (U.S. Citizens Only)
Date of Birth
BC Student ID #
Address Line 1
Address Line 2
Address Line 3
Emergency Contact & Relationship
History of injuries and/or operations (Give Nature and Year)
History of previous illness: (Provide Month and Year)
Do you struggle with depression, anxiety or feeling not like yourself?
Have you ever experienced any of the above feelings? If yes, when? Please explain.
Have you had any other severe illness NOT mentioned above? If so, please explain.
Have you ever used any psychoactive or addicting drugs without prescription?
Do you have a 504 or IEP? If YES, you must submit a completed health form signed by a medical professional.
Click here to download the Health Record Examination form.
Click the "Chose a file" button to upload your Health Record Examination form and any supporting documents.
Click the "Chose a file" button to upload Front of Insurance Card.
Click the "Chose a file" button to upload Back of Insurance Card.