DoD Questionnaires & Forms
Please DO NOT fill out these forms or questionnaires unless specifically requested by DoDMERB.
- Acne Treatment/Isotretinoin (Systemic Retinoid Use) Questionnaire
- Allergies Questionnaire
- Asthma, Reactive Airway, Exercise-Induced Bronchospasm Questionnaire
- Athletics/Recreational Participation Questionnaire
-
Authorization for DoD to Discuss Medical/Dental Information/Status With Appointed Individual(s)
Used To Authorize DoD to Discuss Your Information/Status With Specified Individual(s) - Back Pain Questionnaire
- Cerumen Impaction Questionnaire
- Corneal Refractive Surgery Questionnaire
- COVID-19 Questionnaire
- Digestive Conditions Questionnaire
- Eczema, Atopic Dermatitis, and Dermatitis Questionnaire
- Eye Examination Form
- Food Allergy Questionnaire
- GYN Questionnaire
- Head Injury Questionnaire
- Headache Questionnaire
- Hypothyroidism Questionnaire
- Insect Allergy Questionnaire
- Insomnia Questionnaire
- Learning Disabilities Questionnaire
- Motion Sickness Questionnaire
- Orthodontic Questionnaire
- Orthopedic Injury Questionnaire
- Present Health Questionnaire
- Sleepwalking Questionnaire
- Three Day Blood Pressure and Pulse Check
- Unit Fitness and Activity Participation Questionnaire
- DoDI 6130.03
Send all inquiries and forms to dha.ncr.dod-merb.mbx.helpdesk@health.mil.
Send all password and login questions to dha.ncr.dod-merb.mbx.webmaster@health.mil.