Mobile Wellness Clinic & vision services
mobile wellness clinic to continue in '24-'25 school year
We are excited to continue offering the Poly community health services via our partnership with Southern California Medical Center for the '24-'25 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 JULY:
JULY 2024 Calendar
Please see the flyers below for details on services offered during the month of JULY:
Sign up to receive a SPORTS PHYSICAL exam on 7/11/24. Please sign up for an exam using the Google Form below. To receive a physical, you will need to:
Complete the SPORTS PHYSICAL GOOGLE FORM to make your appointment. You will receive an email that will confirm the actual time of your appointment.
Complete a consent form, which you can find below. Be sure to indicate the type of insurance you have on the consent form in order to receive services. It must also have your parent's signature
Bring your athletic packet with you. You can find a copy of it HERE: https://www.polyhigh.org/apps/pages/index.jsp?uREC_ID=915757&type=d&pREC_ID=1255821
Bring all forms with you on day of your appointment.
JUly sports physical clinic
Poly HS- 7.11.24 Sport Physical.pdfEng HIPPA, Demographic and Consent Forms 9.26.2023.pdfEsp HIPPA, Demographic and Consent Forms 9.26.2023.pdfvision 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.pdfMake 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.pdfEsp HIPPA, Demographic and Consent Forms 9.26.2023.pdfEnglish 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.