Request a Clinic

We are so glad you are interested in providing this great service to support employee wellbeing! There’s just a few things you should know before requesting your clinic.

Important information for your clinic request:

Logistics: Screenings must occur in a private conference room or office. We will supply the appropriate number of clinicians/clerks to accommodate the volume of the clinic. Clinics will require each station to include one table and two chairs. i.e. one clinician = 1 table and two chairs. One clerk = 1 table and two chairs.

Clinic Time: Please ensure that the times you are choosing allow for our staff to be greeted and brought to your reserved screening location prior to the clinic start time. Our team will arrive 30-45 minutes before clinic start times for setup and need 30 minutes at the conclusion of the clinic to tear down. i.e. 9am-4pm clinic would require access to the clinic room and site contact at 8:30am until 4:30pm.

Clinics will be scheduled for a maximum of 6 hours and are determined based on your location distance from our main office. We can offer Monday, Tuesday, Thursday and Friday between the hours of 8:00am and 4:30pm. On Wednesdays, clinics are available between the hours of 11:00 a.m. and 3:30 p.m.

Now let’s get started! Please complete the form below to request a biometric screening clinic for your organization. We require a minimum of 10 eligible participants per location. Please allow 3-5 business days to process your request.

For direct questions, please contact urwell@urmc.rochester.edu

Please note that fields with a red asterisk (*) are required.

How did you hear about us?:

Approx. number of eligible* individuals (minimum of 10):*

Department Name:*

Clinic Site Contact Name:*

Email Address:*

Cell Phone Number:

Office Phone Number:*

Back-up Clinic Site Contact Name:

Email:

Cell Phone Number:

Building Name:*

Street Address:*

Suite Number:

Room Name / Number:

City, State and Zip:*

On-site Parking? (please provide logistical details and if parking is free):*

Handicap Entrance from Parking (if not at URMC campus):*

Location Check-in Details (directions to the location and clinic room):*

Wi-Fi Available:

Yes

Are these clinics open to others in the University?:*

Open

Private

We are excited to bring you our service and your employees will thank you for it too! Due to high demand, we are currently scheduling clinics two months in advance. Please take this into account when requesting dates.

Clinic rooms must be available 30-45 minutes before and after clinics to allow for set up and break down of equipment.

Requested Date(s) and Time(s):

Date:*

Start Time | End Time:*

To request a clinic outside of standard business hours, please include any necessary details in the form below and a member of our team will be in contact with you.

Additional comments or questions:

*For eligibility information, please see our Eligibility and Incentives page.

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