Health History Survey - Patient Questionnaire
Click on the screen shot (left) to log in.
What is the health survey?
Breast Care Center doctors and nurses designed the online Health Survey so that they can have an accurate and current record of your health at their fingertips on your first visit. After providing your email address to the appointment scheduler or new patient coordinator, you will receive an email from bccsupport@ucsfmedctr.org with the information you need to access the survey's protected website. The survey is powered by Dynamic Clinical Systems.
Taking the survey
You can begin the survey by clicking on the picture of the log-in screen above, or on the Health Survey link. For questions or comments regarding the questionnaire, please see the Frequently Asked Questions below, or contact the Survey Coordinator at 415-476-0276.
If you are unable to complete the online survey at home, you will need to come in one hour before your first appointment. Portable tablet computers with electronic pens are available at the front desk. Because we have a limited number of these computers available, we strongly encourage patients to complete the survey at home before their appointment to minimize delays. Also, if you have never used a computer before, please contact the Survey Coordinator (415-476-0276) to set up a time to receive extra assistance.
In the event that you are unable to either complete the online survey at home before your appointment or arrive one hour early to complete it in the clinic, please provide this essential health information to your clinician by completing the questionnaire on your home computer up to two weeks after your appointment.
Upon completion of the questionnaire, you will be directed to a personalized report that summarizes your responses and directs you to resources at UCSF that may be relevant to you.
Frequently Asked Questions
Is my information secure?
All information entered in the questionnaire is heavily protected. The online questionnaire system has been tested at UCSF as well as other institutions and satisfies all HIPPA requirements.
Why is completing this questionnaire necessary?
The completion of the questionnaire has been requested by your physician because your answers are important to your care at the Breast Care Center. Your health information will be printed out and placed in your chart to provide a concise and comprehensive summary of your health history and to track symptoms more effectively in the future. Although you may also be asked to fill out a paper intake questionnaire, we request that you fill out the electronic questionnaire as well because much of the information collected is unique to treating patients with breast issues.
What is the consent to research in the questionnaire?
You have the option of consenting to allow your information to be used in research studies at UCSF. This decision is up to you and the information on the questionnaire will be made available to your clinician whether or not you decide to give your consent.
