Request School Forms

To request school and/or vaccine form(s), please fill out the information below and make a payment. Please allow our office up to 48 BUSINESS hours to complete your request.

"*" indicates required fields

Child's Name

First Name*

Last Name*

School Name*

Child's Date of Birth*

Upload School Forms

Yes

No

$20 For School Forms Upload

Upload School Forms Files

Drop files here or

Max. file size: 2 MB, Max. files: 5.

Upload Medication or Allergy Forms

Drop files here or

Max. file size: 2 MB, Max. files: 5.

School Form 3040 (Yellow)*

$5 for Form 3040

School Form 680 (Blue)*

$5 for Form 680

Sports Form*

$20 for Form EL2

Vaccination History/College Form*

$5 for VHC Form

Over the Counter Medication Form*

$5 for OTC Meds Form *Must upload form to be filled in

Allergy & Rx Meds Form*

$10 for Allergy & Rx Meds Form *Must upload form to be filled in

Contact Phone*

Contact Email*

Delivery Method*

For a $20 convenience fee, the forms may be emailed to you.

Total

Comments

This field is for validation purposes and should be left unchanged.

Our commitment to caring for your family is now available around the clock. Our physical office location may currently be closed, but you can still call (305) 271-8222 to speak with a trusted medical team member at our after-hours call center.

If you are experiencing a medical emergency, please call 911.

To My Dear Patients,

I want to inform you that after both working through a pandemic and my medical leave it became obvious to me and my family it was time for me to retire. Not only do I have the confidence in my partners to care for my own children; they are some of the finest doctors in Pediatrics. One last piece of advice, when you find a gem like them don’t let go and please treat them with the same kindness you afforded me. You will be pleased as you forge these new relationships. Thank you for the privilege of allowing me to care for your children. Wishing you the best of health and contentment.

Warmly,
Dr. Barbara Kaszovitz