Main Administrative Office:
1305 Idlewild Ave, Green Cove Springs, FL 32043 (904) 529-2800

Clinic:
3229 Bear Run Boulevard, Orange Park, FL 32065 (904) 272-3177

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·         Things to bring to your screening

·         Authorization to Disclose Information (DH3203)

·         Consent to Fax DH2116

·         Health History – English/Spanish

·         Initiation of Services DH3204 (Instructions)

·         Notice of Privacy Policy DH 150741

Spanish

·         Autorizacion para Divulgar Informacion Confidencial DH 3203S

·         Consentimiento del Cliente para Enviar Informacion Confidencial por Fax DOH 2216

·         Histroria de Salud Espanol

·         Comienzo de Servicios DH 3204S

·         Aviso sobre Normas Privacidad DH 150742

·         Biomedical Waste Monthly Log

·         Biomedical Waste Permit Application

·         Body Piercing Salon Application

·         Food Service Permit Application (DOH)

·         Food Service Plan Review Application

·         Food Service Temporary Packet

·         Mobile Home/Recreational Vehicle Park Permit Application

·         Public Pools Application for Renewal/Update

·         Swimming Pool Report (DOH) - Monthly

·         Tanning License Application Packet

·         Water System Construction Packet – Limited Use

·         Water System Operating Permit Packet -  Limited Use

·         Water System Registration Form -  Limited Use

·         Water System Variance Request

Septic System Forms

·         Application for Construction Permit

·         Business Survey

·         Operating Permit Application

·         Tank Certification Sheet