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School Clinic appointment request
Please complete this form to let us know that you need to have a clinic visit. We will determine what paperwork you need, if any. When it is your turn to be seen, we will find you in class.
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School
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Bartlett High School
Begich Middle School
Bettye Davis East Anchorage High School
Clark Middle School
West Anchorage High School
Other:
ASD Student ID
*
Your answer
Student Cell Phone (Only general information, not personal details will be texted)
Your answer
Sport(s) - if any
Your answer
Healthcare Need
Physical Exam
Something else
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