Instructions for Completing and Submitting Health Questionnaire Forms

If you are required to participate in the TCU OHSP, you must complete the following questionnaire. In addition, if you are using Concentra, you must include the demographic form, HIPAA release form (both located at the bottom of this page), and required training before engaging in the care and use of animals at TCU and when any changes in your medical condition occur. Please review the below information for additional options and instructions.

On the last page of the health questionnaire form, please read the first sentence and choose either Concentra or Brown-Lupton Health Center before you save and/or print the document.

The TCU Office of Research Compliance offers the following instructions for students and Faculty to improve the process and turnaround times for Health Clearance forms.

Starting January 2022, TCU students who need to complete their annual Health questionnaire and risk assessment forms have the following options.

Students may utilize 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, they can 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 MUST be sent to Research@tcu.edu by the Physician/ health center.

However, students and Faculty (mandatory) may still use Concentra. In addition, we have worked with Concentra to improve our process, improving turnaround times.

1. Complete the Health questionnaire form and the Concentra Patient demographic and HIPAA release form (both located at the bottom of this page), which all patients must sign, to register students and Faculty successfully. Include all documents described above in your Questionnaire packet. Please save all documents as PDF files
2. Students and Faculty can email their completed forms to ARTorres@concentra.comwith “TCU Vivarium Health clearance” in the subject line using their TCU email. Please note if you do not use the correct subject line, this will prolong the turnaround time of these forms. All forms must be filled out completely and saved and sent as PDF files. Any packets not filled out completely will be returned. Concentra’s email is a secured email that the nurse can print and hand to the Medical Director for review and sign-off.
3. You will receive an activity status report of completion and results on the same day, the day after the submission, or the following business day, depending on the day of submission.
4. Concentra will email the results page to Research@tcu.edu.
5. Once received, the Office of Research will forward the signed document to the Faculty or student and copy their Principle Investigator (PI).

***Please do not have forms brought or inter-office the forms to the Office of Research Compliance. ***

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