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Student Health Center

Financial Responsibility




I, as attested by my electronic signature below, hereby agree to pay any and all charges that I incur related to or otherwise arising out of my visit(s) to the University of Dayton Student Health Center, including, but not limited to: X-rays, EKGs, vaccines and medications dispensed by the Student Health Center or ordered through/delivered by a local pharmacy, (including any/all medications ordered by outside physicians), any laboratory tests and other medical or dental services performed at the Student Health Center or by an outside laboratory or other service facility, and billed through the Student Health Center (and therefore ultimately appearing on my student account). I consent to the Student Health Center’s choice, in its personnel’s professional discretion of laboratory or other medical/dental service providers in order to provide the treatment such personnel deem necessary for my well-being. I further agree not to dispute the fees and charges incurred, regardless of the entity providing the services or billing for the charges.


I understand that the Student Health Center does NOT process insurance for medications dispensed or tests performed on Student Health Center premises. If I would prefer to order medications or tests outside of the Health Center so that I can use my insurance, it is my responsibility to notify Student Health Center personnel clearly of that preference. Further, if that is my preference, I understand that I must show my health insurance documentation at the time medications are ordered from a pharmacy or when lab tests or other services are performed in order for the costs associated with such items or services to be processed through my insurance. If I choose not to take such steps to ensure that healthcare charges are processed through my insurance, that means I agree to pay the full price of the medication, tests or other services, and that such items and services will be billed to my student account. In the event I use my insurance but my insurance provider does not cover the full cost of the vaccines, medications or services, I agree to pay the balance (i.e., the portion of the charges not paid by my insurance provider). I understand that the University has no responsibility for the amount my insurance provider may or may not cover.

CONTACT

Student Health Center

937-229-3131