Contact our office if you have any questions. 

Fax 386-424-9130

Phone 386-424-1414

Forms

 Effective September 1st, 2016 there is a  $10 charge

for each of the following forms requested:
1. Routine physical ("Yellow form")
2. Shot record ("Blue form")
3. Sports physical
4. Pop Warner
5. Medication forms
6. FMLA forms
7. Boy/Girl Scouts forms
8. Camp forms
9. Other

Please be sure to update us with all your information!

Remember one​ form per child! 

Stop by our offices to pick up forms 

or

​​Print from here and drop off at our offices.

This is due to the high volume of requests that we receive and the time needed to process and complete such documents.
Note: If you request any form(s) during a routine WELL visit, then the fee will be waived.
Thank you for your cooperation and allowing us to continue to care for your children. We need 24 - 48 hours notice to complete these forms for pick up. Please provide your name, your contact number, your child's name and date of birth.  


/* angular-svg-round-progressbar@0.3.8 2015-10-21 */ // shim layer with setTimeout fallback // credit Erik Möller and http://www.paulirish.com/2011/requestanimationframe-for-smart-animating/ 'use strict'; (function() { var lastTime = 0; var vendors = ['webkit', 'moz']; for(var x = 0; x < vendors.length="" &&="" !window.requestanimationframe;="" ++x)="" {="" window.requestanimationframe="window[vendors[x]+'RequestAnimationFrame'];" window.cancelanimationframe="window[vendors[x]+'CancelAnimationFrame']" ||="" window[vendors[x]+'cancelrequestanimationframe'];="" }="" if="" (!window.requestanimationframe){="" window.requestanimationframe="function(callback)" {="" var="" currtime="new" date().gettime();="" var="" timetocall="Math.max(0," 16="" -="" (currtime="" -="" lasttime));="" var="" id="window.setTimeout(function()" {="" callback(currtime="" +="" timetocall);="" },="" timetocall);="" lasttime="currTime" +="" timetocall;="" return="" id;="" };="" }="" if="" (!window.cancelanimationframe){="" window.cancelanimationframe="function(id)" {="" window.cleartimeout(id);="" };="" }="" }());="" angular.module('angular-svg-round-progress',="" []);="" 'use="" strict';="" angular.module('angular-svg-round-progress').constant('roundprogressconfig',="" {="" max:="" 50,="" semi:="" false,="" rounded:="" false,="" responsive:="" false,="" clockwise:="" true,="" radius:="" 100,="" color:="" "#45ccce",="" bgcolor:="" "#eaeaea",="" stroke:="" 15,="" duration:="" 800,="" animation:="" "easeoutcubic",="" offset:="" 0="" });="" 'use="" strict';="" angular.module('angular-svg-round-progress').service('roundprogressservice',="" [function(){="" var="" service="{};" var="" isnumber="angular.isNumber;" var="" base="document.head.querySelector('base');" fixes="" issues="" if="" the="" document="" has="" a=""> element service.resolveColor = base && base.href ? function(value){ var hashIndex = value.indexOf('#'); if(hashIndex > -1 && value.indexOf('url') > -1){ return value.slice(0, hashIndex) + window.location.href + value.slice(hashIndex); } return value; } : function(value){ return value; }; // credits to http://modernizr.com/ for the feature test service.isSupported = !!(document.createElementNS && document.createElementNS('http://www.w3.org/2000/svg', "svg").createSVGRect); // utility function var polarToCartesian = function(centerX, centerY, radius, angleInDegrees) { var angleInRadians = (angleInDegrees - 90) * Math.PI / 180.0; return { x: centerX + (radius * Math.cos(angleInRadians)), y: centerY + (radius * Math.sin(angleInRadians)) }; }; // deals with floats passed as strings service.toNumber = function(value){ return isNumber(value) ? value : parseFloat((value + '').replace(',', '.')); }; service.getOffset = function(element, options){ var value = +options.offset || 0; if(options.offset === 'inherit'){ var parent = element; var parentScope; while(!parent.hasClass('round-progress-wrapper')){ if(service.isDirective(parent)){ parentScope = parent.scope().$parent.getOptions(); value += ((+parentScope.offset || 0) + (+parentScope.stroke || 0)); } parent = parent.parent(); } } return value; }; // credit to http://stackoverflow.com/questions/5736398/how-to-calculate-the-svg-path-for-an-arc-of-a-circle service.updateState = function(val, total, R, ring, size, isSemicircle) { if(!size) return ring; var value = val > 0 ? Math.min(val, total) : 0; var type = isSemicircle ? 180 : 359.9999; var perc = total === 0 ? 0 : (value / total) * type; var x = size/2; var start = polarToCartesian(x, x, R, perc); // in this case x and y are the same var end = polarToCartesian(x, x, R, 0); var arcSweep = (perc <= 180="" "0"="" :="" "1");="" var="" d="[" "m",="" start.x,="" start.y,="" "a",="" r,="" r,="" 0,="" arcsweep,="" 0,="" end.x,="" end.y="" ].join("="" ");="" return="" ring.attr('d',="" d);="" };="" service.isdirective="function(el){" if(el="" &&="" el.length){="" return="" (typeof="" el.attr('round-progress')="" !="=" 'undefined'="" ||="" el[0].nodename.tolowercase()="==" 'round-progress');="" }="" return="" false;="" };="" easing="" functions="" by="" robert="" penner="" source:="" http://www.robertpenner.com/easing/="" license:="" http://www.robertpenner.com/easing_terms_of_use.html="" service.animations="{" t:="" is="" the="" current="" time="" (or="" position)="" of="" the="" tween.="" this="" can="" be="" seconds="" or="" frames,="" steps,="" seconds,="" ms,="" whatever="" –="" as="" long="" as="" the="" unit="" is="" the="" same="" as="" is="" used="" for="" the="" total="" time.="" b:="" is="" the="" beginning="" value="" of="" the="" property.="" c:="" is="" the="" change="" between="" the="" beginning="" and="" destination="" value="" of="" the="" property.="" d:="" is="" the="" total="" time="" of="" the="" tween.="" jshint="" eqeqeq:="" false,="" -w041:="" true="" linearease:="" function(t,="" b,="" c,="" d)="" {="" return="" c="" *="" t="" d="" +="" b;="" },="" easeinquad:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*(t/="d)*t" +="" b;="" },="" easeoutquad:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c="" *(t/="d)*(t-2)" +="" b;="" },="" easeinoutquad:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" c/2*t*t="" +="" b;="" return="" -c/2="" *="" ((--t)*(t-2)="" -="" 1)="" +="" b;="" },="" easeincubic:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*(t/="d)*t*t" +="" b;="" },="" easeoutcubic:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*((t="t/d-1)*t*t" +="" 1)="" +="" b;="" },="" easeinoutcubic:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" c/2*t*t*t="" +="" b;="" return="" c/2*((t-="2)*t*t" +="" 2)="" +="" b;="" },="" easeinquart:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*(t/="d)*t*t*t" +="" b;="" },="" easeoutquart:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c="" *="" ((t="t/d-1)*t*t*t" -="" 1)="" +="" b;="" },="" easeinoutquart:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" c/2*t*t*t*t="" +="" b;="" return="" -c/2="" *="" ((t-="2)*t*t*t" -="" 2)="" +="" b;="" },="" easeinquint:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*(t/="d)*t*t*t*t" +="" b;="" },="" easeoutquint:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c*((t="t/d-1)*t*t*t*t" +="" 1)="" +="" b;="" },="" easeinoutquint:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" c/2*t*t*t*t*t="" +="" b;="" return="" c/2*((t-="2)*t*t*t*t" +="" 2)="" +="" b;="" },="" easeinsine:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c="" *="" math.cos(t/d="" *="" (math.pi/2))="" +="" c="" +="" b;="" },="" easeoutsine:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c="" *="" math.sin(t/d="" *="" (math.pi/2))="" +="" b;="" },="" easeinoutsine:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c/2="" *="" (math.cos(math.pi*t/d)="" -="" 1)="" +="" b;="" },="" easeinexpo:="" function="" (t,="" b,="" c,="" d)="" {="" return="" (t="=0)" b="" :="" c="" *="" math.pow(2,="" 10="" *="" (t/d="" -="" 1))="" +="" b;="" },="" easeoutexpo:="" function="" (t,="" b,="" c,="" d)="" {="" return="" (t="=d)" b+c="" :="" c="" *="" (-math.pow(2,="" -10="" *="" t/d)="" +="" 1)="" +="" b;="" },="" easeinoutexpo:="" function="" (t,="" b,="" c,="" d)="" {="" if="" (t="=0)" return="" b;="" if="" (t="=d)" return="" b+c;="" if="" ((t/="d/2)">< 1)="" return="" c/2="" *="" math.pow(2,="" 10="" *="" (t="" -="" 1))="" +="" b;="" return="" c/2="" *="" (-math.pow(2,="" -10="" *="" --t)="" +="" 2)="" +="" b;="" },="" easeincirc:="" function="" (t,="" b,="" c,="" d)="" {="" return="" -c="" *="" (math.sqrt(1="" -="" (t/="d)*t)" -="" 1)="" +="" b;="" },="" easeoutcirc:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c="" *="" math.sqrt(1="" -="" (t="t/d-1)*t)" +="" b;="" },="" easeinoutcirc:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d/2)">< 1)="" return="" -c/2="" *="" (math.sqrt(1="" -="" t*t)="" -="" 1)="" +="" b;="" return="" c/2="" *="" (math.sqrt(1="" -="" (t-="2)*t)" +="" 1)="" +="" b;="" },="" easeinelastic:="" function="" (t,="" b,="" c,="" d)="" {="" var="" s="1.70158;var" p="0;var" a="c;" if="" (t="=0)" return="" b;="" if="" ((t/="d)==1)" return="" b+c;="" if="" (!p)="" p="d*0.3;" if="" (a="">< math.abs(c))="" {="" a="c;" s="p/4;" }="" else="" s="p/(2*Math.PI)" *="" math.asin="" (c/a);="" return="" -(a*math.pow(2,10*(t-="1))" *="" math.sin(="" (t*d-s)*(2*math.pi)/p="" ))="" +="" b;="" },="" easeoutelastic:="" function="" (t,="" b,="" c,="" d)="" {="" var="" s="1.70158;var" p="0;var" a="c;" if="" (t="=0)" return="" b;="" if="" ((t/="d)==1)" return="" b+c;="" if="" (!p)="" p="d*0.3;" if="" (a="">< math.abs(c))="" {="" a="c;" s="p/4;" }="" else="" s="p/(2*Math.PI)" *="" math.asin="" (c/a);="" return="" a*math.pow(2,-10*t)="" *="" math.sin(="" (t*d-s)*(2*math.pi)/p="" )="" +="" c="" +="" b;="" },="" easeinoutelastic:="" function="" (t,="" b,="" c,="" d)="" {="" jshint="" eqeqeq:="" false,="" -w041:="" true="" var="" s="1.70158;var" p="0;var" a="c;" if="" (t="=0)" return="" b;="" if="" ((t/="d/2)==2)" return="" b+c;="" if="" (!p)="" p="d*(0.3*1.5);" if="" (a="">< math.abs(c))="" {="" a="c;" s="p/4;" }="" else="" s="p/(2*Math.PI)" *="" math.asin="" (c/a);="" if="" (t="">< 1)="" return="" -0.5*(a*math.pow(2,10*(t-="1))" *="" math.sin(="" (t*d-s)*(2*math.pi)/p="" ))="" +="" b;="" return="" a*math.pow(2,-10*(t-="1))" *="" math.sin(="" (t*d-s)*(2*math.pi)/p="" )*0.5="" +="" c="" +="" b;="" },="" easeinback:="" function="" (t,="" b,="" c,="" d,="" s)="" {="" jshint="" eqeqeq:="" false,="" -w041:="" true="" if="" (s="=" undefined)="" s="1.70158;" return="" c*(t/="d)*t*((s+1)*t" -="" s)="" +="" b;="" },="" easeoutback:="" function="" (t,="" b,="" c,="" d,="" s)="" {="" jshint="" eqeqeq:="" false,="" -w041:="" true="" if="" (s="=" undefined)="" s="1.70158;" return="" c*((t="t/d-1)*t*((s+1)*t" +="" s)="" +="" 1)="" +="" b;="" },="" easeinoutback:="" function="" (t,="" b,="" c,="" d,="" s)="" {="" jshint="" eqeqeq:="" false,="" -w041:="" true="" if="" (s="=" undefined)="" s="1.70158;" if="" ((t/="d/2)">< 1)="" return="" c/2*(t*t*(((s*="(1.525))+1)*t" -="" s))="" +="" b;="" return="" c/2*((t-="2)*t*(((s*=(1.525))+1)*t" +="" s)="" +="" 2)="" +="" b;="" },="" easeinbounce:="" function="" (t,="" b,="" c,="" d)="" {="" return="" c="" -="" service.animations.easeoutbounce="" (d-t,="" 0,="" c,="" d)="" +="" b;="" },="" easeoutbounce:="" function="" (t,="" b,="" c,="" d)="" {="" if="" ((t/="d)">< (1/2.75))="" {="" return="" c*(7.5625*t*t)="" +="" b;="" }="" else="" if="" (t="">< (2/2.75))="" {="" return="" c*(7.5625*(t-="(1.5/2.75))*t" +="" 0.75)="" +="" b;="" }="" else="" if="" (t="">< (2.5/2.75))="" {="" return="" c*(7.5625*(t-="(2.25/2.75))*t" +="" 0.9375)="" +="" b;="" }="" else="" {="" return="" c*(7.5625*(t-="(2.625/2.75))*t" +="" 0.984375)="" +="" b;="" }="" },="" easeinoutbounce:="" function="" (t,="" b,="" c,="" d)="" {="" if="" (t="">< d/2)="" return="" service.animations.easeinbounce="" (t*2,="" 0,="" c,="" d)="" *="" 0.5="" +="" b;="" return="" service.animations.easeoutbounce="" (t*2-d,="" 0,="" c,="" d)="" *="" 0.5="" +="" c*0.5="" +="" b;="" }="" };="" return="" service;="" }]);="" 'use="" strict';="" angular.module('angular-svg-round-progress')="" .directive('roundprogress',="" ['$window',="" 'roundprogressservice',="" 'roundprogressconfig',="" function($window,="" service,="" roundprogressconfig){="" var="" base="{" restrict:="" "ea",="" replace:="" true,="" transclude:="" true,="" scope:{="" current:="" "=", max: " =",="" semi:="" "=", rounded: " =",="" clockwise:="" "=", responsive: " =",="" radius:="" "@",="" color:="" "@",="" bgcolor:="" "@",="" stroke:="" "@",="" duration:="" "@",="" animation:="" "@",="" offset:="" "@"="" }="" };="" if(!service.issupported){="" return="" angular.extend(base,="" {="" placeholder="" element="" to="" keep="" the="" structure="" template:="">
' }); } return angular.extend(base, { link: function(scope, element){ var isNested = !element.hasClass('round-progress-wrapper'); var svg = isNested ? element : element.find('svg').eq(0); var ring = svg.find('path').eq(0); var background = svg.find('circle').eq(0); var options = angular.copy(roundProgressConfig); var lastAnimationId; var parentChangedListener; scope.getOptions = function(){ return options; }; var renderCircle = function(){ var isSemicircle = options.semi; var responsive = options.responsive; var radius = +options.radius || 0; var stroke = +options.stroke; var diameter = radius*2; var backgroundSize = radius - (stroke/2) - service.getOffset(element, options); svg.css({ "top": 0, "left": 0, "position": responsive ? "absolute" : "static", "width": responsive ? "100%" : (diameter + "px"), "height": responsive ? "100%" : (isSemicircle ? radius : diameter) + "px", "overflow": "hidden" // on some browsers the background overflows, if in semicircle mode }); // when nested, the element shouldn't define its own viewBox if(!isNested){ // note that we can't use .attr, because if jQuery is loaded, // it lowercases all attributes and viewBox is case-sensitive svg[0].setAttribute('viewBox', '0 0 ' + diameter + ' ' + (isSemicircle ? radius : diameter)); element.css({ "width": responsive ? "100%" : "auto", "position": "relative", "padding-bottom": responsive ? (isSemicircle ? "50%" : "100%") : 0 }); } element.css({ "width": responsive ? "100%" : "auto", "position": "relative", "padding-bottom": responsive ? (isSemicircle ? "50%" : "100%") : 0 }); ring.css({ "stroke": service.resolveColor(options.color), "stroke-width": stroke, "stroke-linecap": options.rounded ? "round": "butt" }); if(isSemicircle){ ring.attr("transform", options.clockwise ? "translate("+ 0 +","+ diameter +") rotate(-90)" : "translate("+ diameter +", "+ diameter +") rotate(90) scale(-1, 1)"); }else{ ring.attr("transform", options.clockwise ? "" : "scale(-1, 1) translate("+ (-diameter) +" 0)"); } background.attr({ "cx": radius, "cy": radius, "r": backgroundSize >= 0 ? backgroundSize : 0 }).css({ "stroke": service.resolveColor(options.bgcolor), "stroke-width": stroke }); }; var renderState = function(newValue, oldValue, preventAnimationOverride){ var max = service.toNumber(options.max || 0); var end = newValue > 0 ? $window.Math.min(newValue, max) : 0; var start = (oldValue === end || oldValue < 0)="" 0="" :="" (oldvalue="" ||="" 0);="" fixes="" the="" initial="" animation="" var="" changeinvalue="end" -="" start;="" var="" easinganimation="service.animations[options.animation];" var="" starttime="new" $window.date();="" var="" duration="+options.duration" ||="" 0;="" var="" preventanimation="preventAnimationOverride" ||="" (newvalue=""> max && oldValue > max) || (newValue < 0="" &&="" oldvalue="">< 0)="" ||="" duration="">< 25;="" var="" radius="options.radius;" var="" circlesize="radius" -="" (options.stroke/2)="" -="" service.getoffset(element,="" options);="" var="" elementsize="radius*2;" var="" issemicircle="options.semi;" stops="" some="" expensive="" animating="" if="" the="" value="" is="" above="" the="" max="" or="" under="" 0="" if(preventanimation){="" service.updatestate(end,="" max,="" circlesize,="" ring,="" elementsize,="" issemicircle);="" }else{="" $window.cancelanimationframe(lastanimationid);="" (function="" animation(){="" var="" currenttime="$window.Math.min(new" date()="" -="" starttime,="" duration);="" service.updatestate(="" easinganimation(currenttime,="" start,="" changeinvalue,="" duration),="" max,="" circlesize,="" ring,="" elementsize,="" issemicircle);="" if(currenttime="">< duration){="" lastanimationid="$window.requestAnimationFrame(animation);" }="" })();="" }="" };="" var="" keys="Object.keys(base.scope).filter(function(key){" return="" key="" !="=" 'current';="" });="" properties="" that="" are="" used="" only="" for="" presentation="" scope.$watchgroup(keys,="" function(newvalue){="" for(var="" i="0;" i="">< newvalue.length;="" i++){="" if(typeof="" newvalue[i]="" !="=" 'undefined'){="" options[keys[i]]="newValue[i];" }="" }="" rendercircle();="" scope.$broadcast('$parentoffsetchanged');="" it="" doesn't="" have="" to="" listen="" for="" changes="" on="" the="" parent="" unless="" it="" inherits="" if(options.offset="==" 'inherit'="" &&="" !parentchangedlistener){="" parentchangedlistener="scope.$on('$parentOffsetChanged'," function(){="" renderstate(scope.current,="" scope.current,="" true);="" rendercircle();="" });="" }else="" if(options.offset="" !="=" 'inherit'="" &&="" parentchangedlistener){="" parentchangedlistener();="" }="" });="" properties="" that="" are="" used="" during="" animation.="" some="" of="" these="" overlap="" with="" the="" ones="" that="" are="" used="" for="" presentation="" scope.$watchgroup(['current',="" 'max',="" 'animation',="" 'duration',="" 'radius',="" 'stroke',="" 'semi',="" 'offset'],="" function(newvalue,="" oldvalue){="" renderstate(service.tonumber(newvalue[0]),="" service.tonumber(oldvalue[0]));="" });="" },="" template:="" function(element){="" var="" parent="element.parent();" var="" directivename='round-progress' ;="" var="" template="[">', '', '', '', '' ]; while(parent.length && !service.isDirective(parent)){ parent = parent.parent(); } if(!parent || !parent.length){ template.unshift('
'); template.push('
'); } return template.join('\n'); } }); }]);