Form Request Information and Guidelines
Forms include any document that needs to be reviewed by a medical provider and signed
- Requested turnaround time for all form requests is a minimum of 48 business hours.
- This time can be extended to 72 business hours during peak times when the demand for forms is higher – especially summer and fall.
- Special requests for expedited processing can be accommodated only on a limited basis in an emergency and is dependent upon the current volume to be processed for any given day.
- Your child MUST be current on their annual health supervision exam for all forms being submitted for review and signature.
- All forms MUST have the child’s name and date of birth on all pages.
- All forms submitted via email should be in PDF format. DO NOT submit photographs of forms.
Printout of all vaccines that are part of the patient record for:
- Daycares – If requesting the General Health Appraisal, it will automatically come with an immunization record.
- Personal use
General Health Appraisal / Immunization Records – Daycare forms are automatically processed with immunization record
- We only complete the State Approved General Health Appraisal form designed for our office.
- If your daycare requires the CIIS State Form for immunizations, please let us know, or it will be processed with our standard office printout
Any form that is being requested for participation in sports or other activities requires the Sports Questionnaire, as well as the specific form for the activity.
Please be sure to complete all parent required questions before submitting for signature.
Sports Questionnaire – Required for ALL Sport/Camp Forms
|Please submit the specific form required for the individual school
|Scout Related Camps
|Other Summer/Day Camps
|Please submit the specific form for the organization
If no specific form is available, you will be provided with a generic form that confirms the date of the last physical exam and clearance for participation.
- It is our policy not to sign for over-the-counter medications unless needed to treat a specific illness/problem for a limited period of time.
- If for an overnight trip when your child will be away from home, the form required by the organization can be considered for completion.
- Please complete all portions of the medication form before submitting, including:
- medication name,
- administration route,
- and any specific dose instructions.
This helps us ensure that parents understand the medications they are administering to their children, as well as the instructions for use.
- DO NOT include multiple medications on a form that is designed for a single medication. If multiple medications are needed, separate forms should be completed for each medication with dosing instructions.
Any forms that do not fall into the above categories, for example:
- FMLA – all required information completed before submitting for review
To submit forms to be completed, or for questions about forms – email firstname.lastname@example.org
Be sure your email request includes your name, contact information, and your child’s name and date of birth.