Contact us at: | 337-478-6480

Additional Form Requests

Paperwork for schools, daycares, camps, etc.

All paperwork required by schools, daycare, camps, etc. will be filled out free of charge only at well checkup appointments.

Requests for this paperwork to be filled out at any other time will incur a fee (see fee schedule below), or you can make an appointment with a nurse practitioner to complete the form.

To have paperwork filled out other than at a check up appointment, the child must be up-to-date with well check ups (see schedule at right).

The paperwork can be brought to Patient Services at which time the fee will be paid.
The paperwork can be faxed to Patient Services at 337-478-6696 and the fee will be paid when the form is ready for pick up or payment can be provided to our Account Receivable dept. to have the form faxed back upon completion.

See Immunizations for policy regarding shot records.

Fee schedule: $5.00 charge for:

  • school medication administration forms

$10.00 charge for:

  • school/work excuses not associated with an office visit
  • 504 Dx form
  • 90L forms
  • annual summary of visits for tax returns
  • Diabetes forms
  • Headstart forms
  • Incontinent forms
  • Medical history forms for various agencies
  • Sports physicals
  • Letters

No charge for WIC 17 & 48 forms.

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