SHWC Online Inquiry/Request Form

Online Inquiry/Appointment Request Form

If you're experiencing a life threatening medical emergency, STOP! Dial 9-1-1.
This form can be completed to request an appointment with Student Health on any USF campus or to ask a question.

NOT TO BE USED FOR SAME DAY APPOINTMENTS - Please call (813) 974-2331.

SHWC in Tampa is located at: 12530 USF Bull Run Drive, Tampa, FL, 33620 on the purple Bull Runner route. Suggested parking is located in lot 22D off of USF Alumni Drive, between USF Bull Run Drive and USF Genshaft Drive.

We are closed on weekends and USF Observed Holidays/Closures (see below):

* Martin Luther King Day - Jan 19, 2026

* Memorial Day - May 25, 2026

* Juneteenth - June 19, 2026

* Independence Day - July 3, 2026

* Labor Day - Spet 7, 2026
Full Name*

First (Given) Last (Family)
Student U# or Employee ID#*
Email Address*

Confirmation Email
Cell/Mobile #*
Please select one*

I need to schedule a medical appointmentI need a Flu Shot onlyI need to reschedule and/or cancel an appointmentI have a general question
Question(s) *
Complete all remaining fields of the form below if you are requesting a medical appointment. As a result of the American Recovery and Reinvestment Act, the USF Student Health and Wellness Center is required to collect patient data regarding race, ethnicity, and language as part of the information provided to the Centers for Medicare & Medicaid Services (CMS). This information is required for all patients.

Please note: you have not been scheduled until you receive an email confirming the date and time of your appointment.
Birth Date*

MonthDayYear
Gender*

FemaleMale
Marital Status*
Ethnicity*
Race*
Preferred Language*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preferred location for your appointment*
CAMLS Clinic access is limited, please select your student classification

MCOM Medical StudentTaneja Pharmacy StudentCON Nurse Anesthetist StudentNone of the above (please go back and select another location)
Reason for the appointment (your primary complaint)*
Do you have insurance?*

YesNo
Upload Insurance Card (front/back)

Browse Files

Cancelof
Insurance Company Name
Insurance Company Claims Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Insurance Company Phone Number
Member ID/Policy #
Member Group ID #
Insurance Type
Insurance Policy Holder’s Name

First NameLast Name
Relationship to Policy Holder’s
Policy Holder Date of Birth

MonthDayYear
Insurance Policy Holder’s Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Insurance Policy Holder’s Phone Number*
Have you been to the clinic before?*

Yes, I am an existing patient.No, I am a new patient.
Preferred appointment day*

MondayTuesdayWednesdayThursdayFridayFirst available, any day
Preferred appointment time*

Morning (8am to 12pm)Afternoon (12pm to 5pm)First available, any time
Please select preferred appointment time ranges for GYT*

8:30am to 10am (available only on Fri, 4/4/25)10am to 12pm12pm to 2pm2pm to 4pm4pm-4:30pm (available only on Fri 4/4/25)First available, any time
Will this visit be related to an injury?*

YesNo
If yes, were you at work when the injury occurred?*

YesNo
Do you want to reschedule?

Yes, I would like to reschedule (we will contact you via cell/email)No, I would like to cancel my appoitnment
Select the date/time of the appointment you are rescheduling/canceling

MonthDayYear
Date
:HourMinutesAM/PM Option
You will be assessed a fee for missed appointments (i.e. No Shows), late cancellations or late arrivals.

Cancellation requests received after 12pm (noon), the business day before the scheduled appointment time will be subject to this fee.

Please note: Dermatology appointments are limited and therefore the patient must cancel by noon two business days prior to avoid the fee.
Should be Empty:

Online Inquiry/Appointment Request Form