Health Department Forms Sections

Welcome to Citrus County Health Department George A. Dame Community Health Center Website

	Birth and Death Certificates
	Urgent Care Clinic
	Adult Health Care
	Family Planning
	Children's Care
	WIC / Nutrition
	Healthy Start/Mom Care
	Dental Care
	Pharmacy
	Environmental Health
	Disease Control (Epidemiology)
	Phoenix Substance Abuse Treatment
	Tobacco Prevention
	Disaster Preparedness

	NEW! Pertussis (Whooping Cough)
	2011-2012 Flu Season
	Recalls and Bulletins

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Emergency Management Website

Emergency Contact Information Registration

Health Department Forms

Birth and Death Certificates

Birth Certificate Form (01/2010)
Death Certificate Form (03/2012) Updated!

Dental Child Administration Forms

Financial Eligibility (02/2011)
Statement of Understanding (07/2011)
Initiation of Services (English) (11/2008)
Initiation of Services (Spanish) (02/2009)
Dental Health History (02/2011)

Dental Adult Administrations Forms

Financial Eligibility (02/2011)
Statement of Understanding (07/2011)
Initiation of Services (English) (11/2008)
Initiation of Services (Spanish) (02/2009)
Dental Health History (02/2011)

Main Administration Building | 3700 West Sovereign Path | Lecanto, FL 33461 | (352) 527-0068

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