SBHC Appointment Request

Request an Appointment
School-Based Health Center

Students, if you're looking to request an appointment at the School-Based Health Center at any of the following schools, you're in the right place!
- Meadowdale High School (425-835-5225)
- Mountlake Terrace High School (425-835-5227)
- Cascade High School (425-551-1150)
- Everett High School (425-551-1140)
Submit this form to request your appointment, but please note that it's just a request. We'll get back to you to confirm your appointment time. Or, if you prefer, give us a call one of the clinic numbers listed above or drop us an email at sbhc@chcsno.org. We're excited to see you soon
Has the student ever been seen at one of our School-based Health Center locations?*

YesNoI don't know
Important Information About Minor Consent

Under Washington State law, youth may independently access reproductive health care at any age without parental/guardian consent. Youth (age 13 and older) may independently receive drug and alcohol services and mental health counseling without parent/guardian consent. Consent from the student is required to release information regarding their reproductive health, mental health (over 13), and/or substance use (over 13).

If you would like to access the above listed healthcare services without parental consent, and you are not a registered patient with the Health Center, please request an appointment using the form below.
Please request an appointment using the form below and someone from the Health Center will contact you about whether or not a patient registration form is on file.
What school does the student attend? At this time, services are only available to students who attend schools in the dropdown menu. *
Who is completing this form?*
Student Name*

First NameMiddle NameLast Name
Student's Birth Sex*
Student Date of Birth*

MonthDayYear
Contact Number:*
E-mail
example@example.com
What time works best during the week for a phone call to set up an appointment? (Select all that apply)*

8am - 11am11am - 2pm2pm - 4pmOk to leave voicemailOther
For HS Students: What class periods are you available for an appointment?
What Type of Appointment are you Requesting? *
Which vaccines do you need? (check all that apply)

MMRTdAPMCV (Meningococcal)IPV (Polio)Hepatitis BHepatitis AHPVMeningococcal BVaricellaI don't know/unsure
Reason For Visit
Preferred Language
Request a Dental Appointment-Meadowdale
Request a Dental Appointment-MLT
For help, email our support team at sbhc@chcsno.org
or call 425-835-5225.
Should be Empty:

Request an Appointment

School-Based Health Center