Mobile Wellness Clinic & vision services

mobile wellness clinic to continue in '23-'24 school year

We are excited to continue offering the Poly community health services via our partnership with Southern California Medical Center for the '23-'24 academic year. On select dates, students, staff, and community members can receive these services from the convenience of this on-campus mobile facility. Please see below for the services being offered in the month of MARCH:

march 2024 Calendar

Please see the flyers below for details on services offered during the month of MARCH:

Poly HS- Vision 3.21.24.pdf

march vision clinic

Sign up to receive an eye exam on 3/21/24. Please sign up for an exam using the Google Form below. Next, complete a consent form, which you can find below, and indicate the type of insurance you have in order to receive services. You can submit consent forms in the clinic boxes which can be found on the main office counter.  

vision services information

See below to register for a free vision exam and/or free glasses.

Consulte a continuación para registrarse para un examen de la vista gratuito y/o lentes gratis.

Poly Vision Services Protocol.pdf

Make an appointment for your vision services using the Google Form above. 

consent/hippa forms for mobile clinic

Eng HIPPA, Demographic and Consent Forms 9.26.2023.pdf
Esp HIPPA, Demographic and Consent Forms 9.26.2023.pdf

English Consent/Privacy Forms

**Effective October 2023 - all students receiving services must show proof of some type of insurance whether it's private or MediCal. Sorry, but Kaiser plans are not accepted. Please use this updated consent form to indicate what type of insurance you have.**

Please print, sign, and bring this with you 

prior to receiving services at the mobile clinic.

Spanish Consent/Privacy Forms

**A partir de octubre de 2023: todos los estudiantes que reciben servicios deben mostrar prueba de algún tipo de seguro, ya sea privado o MediCal. Lo sentimos, pero no se aceptan planes de Kaiser. Utilice este formulario de consentimiento actualizado para indicar qué tipo de seguro tiene.**

Please print, sign, and bring this with you 

prior to receiving services at the mobile clinic.