These forms should be as complete as possible. This information is necessary as it helps us to accurately treat students, and immunization records are required by law.
The completed forms are submitted online.
- If you have any questions, please contact the Health Center Administrative Assistant, Nicole Coy at: firstname.lastname@example.org
*You may take photos of your health insurance and/or prescription cards using your cell phone camera in order to upload. Please be sure to include front and back.
Monday-Friday 8:30 a.m.-5 p.m. (closed for lunch 12:00-1:00 p.m.)
We can be reached during regular office hours at 330.569.5418