Donate Today

Sandy Segal Youth Health Center
  • Sign In
  • Create Account
  • My Account

  • Signed in as:

  • filler@godaddy.com

  • My Account

  • Sign out

  • Home
  • Support Friends
  • For Students
  • Partners
  • Contact Us
  • Donate
  • More
    • Home
    • Support Friends
    • For Students
    • Partners
    • Contact Us
    • Donate
Sandy Segal Youth Health Center

Signed in as:

filler@godaddy.com

  • Home
  • Support Friends
  • For Students
  • Partners
  • Contact Us
  • Donate

Account

  • My Account

  • Sign out

  • Sign In
  • My Account

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

Copyright © 2023 Friends of the Culver City Youth Health Center - All Rights Reserved.

Federal Tax ID 95-4209374