Forms, Policies and Fees

Patient Forms and Policies

The following PDF forms can be printed, completed, and returned to the Health Clinic as requested.

Service and Uninsured Fees

Our team offers a variety of family practice services and aims to provide you with the best care.

Some services may have fees. There may also be fees if you are not insured. Fees are subject to change and must be paid at the time of service. Payment methods include MasterCard, Visa, American Express, and Debit.

Medical Service Fees

  • Improper cancellation/missed appointment: $50
  • Office visit with expired or no health card: $50
  • Physical exam: $80
  • Sport physical: $60   
  • Injection/vaccine: $20
  • Ear syringing: $30
  • Liquid nitrogen: $10
  • Plan B: $20

Documentation Fees

  • Forms (approximated): $40
  • Work sick note (faculty and staff): $20
  • Work sick note (student): $10 
  • Transfer of medical records: $25