NCWC: Wellness/Health Center--Forms

Medical Services | Counseling | Immunizations | Updates | Forms I Student Insurance Brochure

Health Services

Contact:
Holly Fairley, RN
Coordinator of Health Services
252-985-5186
hfairley@ncwc.edu

Health Services Forms

To view these documents, it is necessary to have the Acrobat Reader installed on your computer.

Note: Downloadable forms on this website require Adobe Reader. Acrobat Reader is free software which you MUST have to open and read pdf files. If you do not have Acrobat Reader on your PC, download it from http://www.adobe.com/products/acrobat/readstep2.html

When you need medical services, you must take a claim form with you which can be downloaded below. If you need a prescription filled, you can submit a receipt and Prescription Claim Form to Academic Health plans for reimbursements. To find a participating pharmacy in your area, call WellDyne Rx at 1-888-479-2000 or go to the www.welldynerx.com.

Insurance Waiver Form

Student Insurance Brochure

Prescription Claim Form

Medical Claim Form