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Home >> Recreational Sports and Wellness >> Student Health Services >> Medical Reimbursement Form >> Print Medical Reimbursement Form >> Print Medical Reimbursement Form

Print Medical Reimbursement Form

Southern Polytechnic Students

Medical Reimbursement Form

Name: ___________________________________

Student ID: _______________________________

Address: _________________________________

_________________________________________

Note:

All students are given a maximum of $100 per semester for use at Wellstar Powers Ferry Urgent Care. It only applies during the semester you are enrolled. You must be bring your receipt, ID, and medical reimbursement form to the Nurse’s office in the Recreation and Wellness Center. Online students and Georgia Highlands students are not eligible for the $100 health credit.