NMWC Forms & Fees

Students can utilize the NMWC services to complete medical forms and requirements for our Nursing & Allied Health programs. The Clinic provides a convenient low cost option for students to receive: Physical Exams, Titers*, Tuberculosis Screenings (PPD testing) and Immunizations. Our office manager can provide individualized assistance for completing forms as well as scheduling clinic services. Appointments are required.

Allied Health Programs

Allied Health Checklists
Student Admission Physical Form
One-Step Tuberculin Skin Test Form
Two-Step Tuberculin Skin Test Form
Healthcare Personnel Vaccination Recommendations



UPMC Medical Clearance for Respirator Fit Testing
UPMC Student N95 Process


Vaccination Waivers
Complete and submit to ahvaccinewaiver@allegany.edu for approval of your waiver request

Allied Health Vaccination Waiver Request - COVID-19 and Influenza


Physical Exams:  
School Physical $25.00  
Sports Participation Physical $35.00  
Well Exam $25.00  
Health Risk Assessment (HRA) FREE  
Tuberculin Skin Test 2-step (PPD):  
(2-step TST requires 4 appointments within a 3-week time period)    
Step 1 Administer $20.00  
(Present to clinic for administration, return to clinic 48-72 hours for result)    
Step 2 Administer one week after step 1 result $20.00  
(Present to clinic for administration, return to clinic 48-72 hours for result)    
TDAP (tetanus, diphtheria, pertussis) $60.00  
Hepatitis B $60.00  
Influenza $30.00  
Hepatitis B  $40.00  
MMR  $120.00  
Varicella  $40.00  
Wellness Screenings:  
Cholesterol  (requires fasting 15 hours, NO caffeine) $30.00  
Diabetes screen Hemoglobin A1c $20.00  


Appointments are required: Please call Anna Kephart, NMWC Office Manager @ 301-784-5670


Cash, check, or credit card payment will be collected at the time of service.

Services may also be paid using financial aid (via the bookstore) for eligible students. 


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