Davis Health Clinic hours are: Tues and Thurs between 12p - 4p. If you need help with paperwork or have questions, support is available: 10a-2p Mon-Wed or during regular clinic hours.

Who is referring?

Parent
Student
Nurse
Counselor
Administrator

Patient Information:

Student First Name:
Student Last Name:
Grade:
Best Contact Phone
Contact Name:
Referral Reason:
Regular Doctor/Clinic?
If so, Doctor/Clinic Name:
Comments: