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)
• New Patient Information Forms
• 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