On-Campus Scheduling

Book Your Appointment

Fill out the form below and we'll confirm your appointment within 24 hours. No travel required — we come to your campus.

Full Name *

Student ID *

Email Address *

Phone Number *

Campus *

Service *

Preferred Date *

Preferred Time Window *

Additional Notes (optional)

verified_userHIPAA Privacy Notice

Your drug screening results are Protected Health Information (PHI) under HIPAA. By submitting this form, you consent to Ark of Hope II collecting, processing, and transmitting your results in accordance with our Privacy Notice. We never sell or share your PHI without your explicit consent, except as required by law.

I have read and acknowledge the HIPAA Privacy Notice. I consent to the collection and secure handling of my health information for the purpose of drug screening.

schoolShare Visit Record with Your Institution(optional)

Some programs require proof of screening completion. Checking this box authorizes Ark of Hope II to share your name, student ID, service type, and visit date with your institution's designated compliance coordinator. This is entirely voluntary and does not affect your ability to receive services.

I authorize Ark of Hope II to share my visit record (name, student ID, service type, and visit date) with my institution's compliance coordinator for academic compliance purposes.

info

No payment required yet

Submitting this form is free. Once Geralah confirms your campus slot is available (within 24 hrs), you'll receive a secure Square payment link by email to complete your booking.

You will receive a confirmation email within 24 hours. Appointment dates are subject to campus availability.