Instructions for Completing and Submitting Health Questionnaire Forms

If you are required to participate in the TCU Occupational Health and Safety Program (OHSP), you must complete a Health Clearance form. In addition, you must be cleared by the Office of Research and have completed the required training before engaging in the care and use of animals at TCU. This also includes any changes in your medical condition. The health clearance form is a questionnaire reviewed by medical professionals, either at the on-campus health center or through Concentra, our contracted third-party medical clinic.

Please read the following information carefully.

TCU Office of Research offers the following instructions to our animal care and use researchers and personnel, to improve the process and turnaround times for Health Clearance forms:

• Students (undergraduate and graduate) will complete the TCU Health Center Questionnaire (see form below) and go to the TCU Brown Lupton Student Health Center by making an appointment. Students will not be able to drop off forms at the health center. However, expect to be seen by a physician and answer some basic medical history questions before the document is signed. The last page of the form MUSTbe sent to research@tcu.edu by the physician/ health center.
• Faculty, including postdoctoral fellows and staff, will complete the Concentra Questionnaire (see form below). If you wish to use your personal physician, then the last page of the form MUSTbe sent to research@tcu.edu by your physician. If using Concentra, please follow the next steps:

1. Complete the Concentra Patient Demographic and Employer HIPAA Release forms (both located at the bottom of this page), which all patients must sign, to register faculty, fellows, and staff successfully. Include all documents described above in your Questionnaire packet (three forms in total). Note: documents must be completed fully (do not highlight checkboxes or sections), and please save all documents as PDF files.
2. Using your TCU email, send the questionnaire packet to forestpark@Concentra.com with the subject line set as “TCU Attention Vanessa”. All forms MUST be filled out completely, saved and sent as PDF files. Any packets not filled out completely will be returned. Concentra’s email is a secure email that the nurse can print and hand to the Medical Director for review and sign-off. Failure to follow these instructions will prolong the turnaround time of these forms.
3. Concentra will process questionnaire packets and complete their review. Results will be provided on the same day, the day after the submission, or the following business day. Concentra will email the results to research@tcu.edu.
4. Once received, the Office of Research will forward the signed document to the faculty, fellow, staff or student and copy their principal investigator (PI).

***The forms are confidential and should only be shared with a medical professional. The health forms are not to be submitted to your Principal Investigator or the Office of Research.***

TCU Health Center – Questionnaire and Risk Assessment for TCU Personnel in Contact with Animals
Concentra – Questionnaire and Risk Assessment for TCU Personnel in Contact with Animals
Concentra patient Demographic form
Concentra patient Demographic form Spanish
Employer Auth PHI HIPPA release