CCSS Telehealth Interest (Staff)
Please fill out this form is you are interested in enrolling in the school based telehealth service. CCSS Telehealth offers students and staff a health clinic on campus that can be used during the school day. The provider can perform basic tests, prescribe medicine, and facilitate telemedicine conferences with out of town doctors and specialists.
By filling out this form, you are providing your basic information so the enrollment packet can be sent to you via email. 
Thank you,
CCSS Telehealth
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First Name *
Middle Name *
Last Name *
School Location *
Do you have health insurance?  *
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