Welcome to the UCLA Medical History Online Portal

Please only complete the questionnaire(s) applicable to you.

The annual Respirator Questionnaire is not necessarily a requisite for the annual Animal Questionnaire (MHQ).

Please allow up to 10 business days for your forms to be processed.

Take the Animal Questionnaire

All personnel involved in the care and use of research animals, including those in DLAM, investigator staff/students, those who handle animal tissues, and all PIs and faculty sponsors of Animal Research Committee (ARC) protocols (regardless of whether they handle animals), must complete the annual animal medical history questionnaire. Visit this FAQ for additional information.

Take the Respiratory Questionnaire

All personnel who wear respirator protection (e.g N-95), must complete the annual respirator medical evaluation questionnaire. However, if you are UCLA Health personnel, please contact UCLA Health EH&S at (310) 267-9888.

Student Questions: please e-mail asheimmune@ashe.ucla.edu || Faculty & Staff Questions: please e-mail MHQOHFQuestions@mednet.ucla.edu || Technical Questions: please e-mail: mhqsupport@mednet.ucla.edu