Seasonal and H1N1 Flu Reporting Form

Woodbury University is tracking the presence of both the seasonal and H1N1 flus on our campus.  Additionally, we wish to provide information and support to any member of our campus community who has questions or concerns about preventing or treating the flu. 

If you believe you have contracted either the seasonal or H1N1 flu, please enter your information below.  Your information will be sent directly to the Campus Nurse and will be kept confidential.

 

Name:
Major:
Symptoms:
Date you first noticed symptoms:
Have you been diagnosed with the flu by a medical professional? Yes
No

If you have a question regarding the prevention or treatment of the flu, or if you would like the Campus Nurse to call or email you to check in with you, please enter your contact information below:

Phone number:
Email Address:

You may also contact the Health Services Office at (818) 252-5238.  In the event of a medical emergency, please dial 911. For more information regarding LA County’s response to the flu, visit http://www.ph.lacounty.gov