Well Child Care Appointments Forms
For your convenience, you can download and complete the Health Questionnaires below and bring to your next Well Child Care (WCC) appointment. Please note that questionnaires are age specific and should be completed according to your child’s exact age.
- 1 Month WCC
- 9 Month WCC
- 12 Month WCC
- 15 Month WCC
- 18 Month WCC
- 24 Month WCC
- 30 Month WCC
- 3 Years WCC
- 4 to 11 Years WCC
- 12 to 18 Years WCC
- Health Leads Social Needs Screener
- Health Leads Social Needs Screener (Spanish)
Upon request, we will provide a School Entry Health Exam (Form DH3040) and a Florida Certificate of Immunization (Form DH680) at the Time of your Well Child’s Appointment. Please note that a fee will be charged if forms are requested at a later date. Please allow 5 to 7 business days for your form to be completed. If you child is up to date, you can request an expedited service (1-2 office business days), if available at the time of the request, for Forms DH3040, DH680 and school sport for a extra fee.
