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You are here: Student Health And Wellness Appointment Scheduler Form
STUDENT HEALTH & WELLNESS APPOINTMENT SCHEDULER FORM
The Student Affairs Division is here to help you manage conflicts, stress, and the many challenges connected to being in college through our Health and Wellness Division, as well as through other targeted resources in Student Affairs. If you are an undergraduate, graduate, law student or recent alum, please complete the following form and e-mail it to us so that we can help you receive the services that most meet your needs. Your information will remain confidential. We appreciate your confidence and trust!

IF YOU ARE A ST.THOMAS UNIVERSITY STUDENT SEEKING AN APPOINTMENT WITH DR.DIGREGORIO OR YOU WANT OTHER HEALTH SERVICES, COMPLETE THIS FORM. You will hear back from us in approximately 48 to 72 hours with appointment times and information.
STUDENT FIRST NAME
STUDENT LAST NAME
STUDENT AGE
STUDENT MAJOR FIELD OF STUDY
STUDENT HOME PHONE
STUDENT CELL PHONE
STUDENT ADDRESS
STUDENT CITY
STUDENT STATE
STUDENT ZIP
EMERGENCY CONTACT NAME
EMERGENCY CONTACT PHONE
TYPE OF SERVICE
ACADEMIC LEVEL
LIVING STATUS
APPOINTMENT AVAILABILITY
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HOW SOON DO YOU WANT TO BE SEEN FOR YOUR CONCERN?
WHO AND WHERE WERE YOU LAST TREATED FOR YOUR CONCERN?
DO YOU HOLD UNIVERSITY HEALTH INSURANCE?
REMEMBER IF THIS IS A LIFE THREATENING EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR GO TO THE CLOSEST EMERGENCY ROOM
LEVEL OF IMPORTANCE
AREA(S) OF CONCERN
BRIEFLY, WHAT RECENT PROBLEMS HAVE YOU HAD THAT LEAD YOU TO ASK FOR HELP?
HAVE YOU HAD THESE OR SIMILAR ISSUES IN THE PAST?