Important Clinic Forms

Please return all signed forms to the front desk of the clinic.

• Consent Packet
  • The consent packet is a crucial document for the enhancement of your child’s healthcare. Without this document the clinic will only be able to provide emergency clinical services.
  • School Clinic Consent Packet 2023

• Designation of Health Care Surrogate for Minor
  • For immunizations or routine medical/dental non-emergency care (including ordinary immunizations, blood testing, TB testing, well-childcare, and ordinary and necessary examination and treatment) which do not require surgery, general anesthesia, psychotropic medicines, or any other extraordinary procedures.
  • Designation of Health Care Surrogate for Minor

• Florida High School Athletic Association Athletic- Pre-Participation Physical Evaluation
  • To be used for school entry and sports physical.
  • https://fhsaa.com/documents/2023/3/3/EL2_Form.pdf