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Request an appointment

Fill-out the information that pertains to your request for an appointment at the Health Center.

The information on this form is confidential.

If you would like to see us today, please call us at 253-535-7337.
In an emergency, call 7911 from on campus or 911 from off campus.

Full Name: *

First *

middle

Last *

Preferred phone number: *

What is your email address? *

What is the reason for your visit?

* Acute illness (cold, flu, stomach ache)
Allergies
Asthma
Birth Control (start)
Birth Control (refill)
Blood test ordered by someone outside of the PLU Health Center (you must bring a written order)
Emergency Contraception ("Plan B")
Follow-up from a previous visit
I was referred by the Counseling Center.
Immunization(s)
Men's Health Visit
Women's Health Visit
Mental Health
Rash, acne, or skin issue
Pap Test (Cervical Cancer Screening)
Personal (I'd rather not say)
Physical Examination
STD and HIV Screening
Travel Consultation (without physical examination)
Tuberculosis Test
Other (please specify below)

Other

If you are coming in for a physical examination, please tell us why:

Sports
Travel
Employment
School
General wellness (check-up)

If you are coming in for a PHYSICAL EXAMINATION FOR ATHLETICS, which sport(s) so you play?

Which nurse practitioner would you prefer to see?

Marit Featherstone FNP, ARNP
Matthew Freeman DNP, MPH, ARNP
Tamsin Sarich FNP, ARNP

* It doesn't matter
Marit Featherstone FNP, ARNP
Matthew Freeman DNP, MPH, ARNP
Tamsin Sarich FNP, ARNP
Any male provider
Any female provider
I am coming in for a blood test, immunization or tuberculosis test only.

Which days or times do you prefer? *

We will automatically send you email, call you, or send a text message to remind you of your appointment? Is this okay? (Text and email reminders serve only as a COURTESY. It is always your responsibility to remember your own appointment time, and to arrive at the Health Center on time.) * YesNo

Need assistance with this form?

Contact

Health Center

253-535-7337

health@plu.edu

253-536-5042 (Fax)

PLU Health Center 121st St. & Park Ave.

Tacoma, WA 98447-0003

Hours

The Health Center is open Monday through Friday from 8 am to 5 pm. We are closed from noon to 1 pm daily for lunch.

Emergency

In an emergency, call 7911 from on campus, or 911 from off campus.

Health Center

Request an appointment

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