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Sandy Segal Youth Health Center
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Sandy Segal Youth Health Center
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LINKS

Culver City Unified School District

CULVER CITY UNIFIED SCHOOL DISTRICT

Venice Family Clinic

Venice Family Clinic

FORMS

Consent for Medical and Mental Health Services

Needed for routine or sports physical exam and all health problems EXCEPT immediate mental health needs and anything related to teen reproductive health.

SSYHC Medical Consent Form plus BH (English) (pdf)Download
SSYHC Medical Consent Form plus BH (Spanish) (pdf)Download

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Federal Tax ID 95-4209374