URBAN ACT Academy and Shalom Health Care Center have joined forces to operate a school-based health clinic, providing access to quality health services for students. In accordance with Indiana State Law, all families wishing to receive health services from Shalom’s school-based clinics (SBC) must sign a consent to treat form and complete a brief medical history. This information provides our medical staff with the most up-to-date medical information for your child. Any information given will remain confidential as part of your child’s medical record. The consent form will be invalid if any portion of the form is not fully complete.

Consent to Treat (ENG)

Informed Consent Form

For More Info & PDF Form Click the Link Below

 

Make it stand out

Para obtener más información y formulario PDF, haga clic a continuación