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It's a New Day in Public Health.

The Florida Department of Health works to protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts.

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Patient Forms

Contact us

Please print and complete the forms with your child’s information. You will need to bring the forms and a photo ID to your child’s first appointment.
 
Due to HIPAA regulations, please do not e-mail forms to the clinic.
 
New Patient Forms (English)  (PDF 1005KB)
New Patient Forms (Spanish) (PDF 1MB)

Notice of Privacy Practices (English) (PDF 2MB)
Notice of Privacy Practices (Spanish) (PDF 2MB)