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
Please Note that we do not require Health Questionnaires for your child’s 2, 4, 6 Month WCC Appointments.
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 $10 per form fee will be charged if forms are requested at a later date. Please allow 5 to 7 business days for return of your completed form. You can request an expedited service for Forms DH3040 and DH680 for a fee of $20.00.
