Common Contracts
1 similar Registration and Financial Agreement contracts
DEPENDENT REGISTRATION AND FINANCIAL AGREEMENT FOR ACCESS TO WILCE PHARMACYRegistration and Financial Agreement • October 17th, 2011
Ohio State Students: Use this form to register your dependent(s) to have their prescriptions filled at the Student Health Services Pharmacy located within the Wilce Student Health Center. Co-pay or co-insurance amounts are due at the time of service. If you are not covered by a participating prescription plan or have not paid your Student Health Insurance premium in full, then payment in full is required prior to receipt of the medication.
