Forms

To save you time, these forms can be printed out, filled in, and brought to the Santa Rosa County Health Department prior to your visit.

All forms are in Portable Document Format (.pdf) and require Adobe Reader to view them. If you don't have the Reader, please click on the logo to install it.  Get Adobe Reader button - opens a new window

Birth and Death Records Forms

If you need a copy of your or your children's Florida birth record:

    Application for a Florida Birth Record (.pdf 297kb)

To correct clerical errors on an existing Florida birth record:

    Application for Amendment to Florida Birth Record (.pdf 349kb)

Instructions on how to fill our the Amendment to Florida Birth Record:

    Application for Amendment Instructions (.pdf 46kb)

To amend a Florida Birth Record, you will also need to fill out this form:

    Affidavit of Amendment of Certificate of Live Birth (.pdf 349kb)

To request a copy of a Santa Rosa County death record, please fill this out:

    Application for a Florida Death Record (.pdf 188kb)

 

Clinic Forms

This form lets us know who you are and why you are at the clinic:

    Clinic Appointments (.pdf 6kb)

If you need a record of immunizations required for school or daycare:

    Form 680 Request (.pdf 64kb)

If you are requesting an immunization (a "shot"):

    Immunization Request (.pdf 10kb)

 

Disease Control (Epidemiology)

If you believe you have come in contact with tuberculosis (TB), open this form and read the questionnaire. If you can answer "yes" to any of the questions, please print the form, fill out all the information, bring in to the Health Department and request to speak to the TB nurse:

    TB Questionnaire (.pdf 16kb)

This page was last modified on: 04/3/2013 03:33:20