We will gladly complete these forms for you. In order to do this, your child should have had a well child visit within the past 12 months. Visits for an illness address a specific problem and are not comprehensive enough for us to complete these forms. There is no charge for completing these forms when completed at the well check. When forms are uploaded or dropped off after a well visit there is a fee but please allow us 48 hours.

They can be uploaded to forms@pod.pcc.com, mailed or faxed, or upload by clicking on the button below.  A copy of your child’s shot record will be included with each form. Complete as much of the form as possible, including any medical history. You can also print your shot records from your patient portal at pod.pcc.com/portal.

Click on the button to upload the form. The form is automatically submitted after the upload is finished. Be sure to indicate whether you will pick up the completed forms, or if you wish to have them emailed, faxed, or mailed to you.

Most camps provide the parent with the forms as some want very specific information like the child’s heart rate after jumping in place 10 times. Check your school or camp’s website to see if they provide a specific form. If no specific form, most schools and camps will accept the standard UIL form. Please fill out all patient information. Click our link below to download.