Clinic Forms
Contact Us
- 904-529-2800 or 904-272-3177
- ClayCHDWeb@flhealth.gov
-
Mailing Address
PO Box 578
Green Cove Springs, FL 32043
Clinical Services Forms
- Authorization to Disclose Confidential Information (DH3203) | Autorizacion para Divulgar Informacion Confidencial
- Health History (English/Espanol)
- Notice of Privacy Policy | Aviso sobre Normas Privacidad
- New Patient Information Forms / NuevosFormularios de Informacióndel Paciente
- Initation of Services | Comienzo De Servicios | Inisyasyon Sevis
- School Entry Health Exam (DH3040-CHP-07-2013) (Instructions)
- School Sports Physical Form
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