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It's a New Day in Public Health.

The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & 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 1,392 KB)
New Patient Forms (Spanish) (PDF 885 KB)