Douglas County School System - School Based Health Center Appointment Request Form

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Appointment Request Form

Parent Name *

Phone Number *

What school does your child attend? *

Type of appointment *

Well-Check

Sick Visit

Sports Physical

Immunizations

Mental Health Counseling

COVID-Testing or COVID Immunization

Thank you for requesting an appointment. A provider from our clinic will contact you to set up your appointment.

Our clinic can provide services that include: annual physicals, sports physicals immunizations, well-checks, sick visits, mental health screenings and services. We can also file your insurance, offer self pay options, and has a sliding fee scale based on income.

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