Rehoboth Beach Location
F:(302) 645-2199
18947 John J Williams Highway
Suite 212
Rehoboth Beach, DE 19971
We encourage families to bring forms to wellness visits!
We are happy to complete forms at that time. Be sure to complete the parent portion first and utilize the patient portal to obtain vaccine records!
Outside of wellness visits, we do have a $5 form fee as well as $15 urgent/rush fee for 24-48 hour turn around! All forms can take our office up to 5-7 business days to complete!
New Patient Registration
Please complete these forms prior to your appointment and bring them with you to ensure a smoother and quicker check in process.
18+ Year Old Updated Consent Form
Please fill out if you are now 18 years of age. Update anytime information changes. Please complete all sections!
Pop Warner Form
The Parent Portion of this form is to be completed and dropped off at the office for a provider to complete.
Records Release
Please fill out one per child. This can be used to have records sent to or from the office. Please complete all sections!
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DIAA/ Sports Form
Sports form for 2024-2025 to be completed by parent and faxed or dropped off at our office to be completed by our medical staff and doctors.
School Physical form Pre k-Grade 6
The Parent Portion of this form is to be completed and dropped off at the office for a provider to complete.
Updated Consent Form
Please fill out an update anytime information changes. Please complete all sections!
Day Care Form
Parent Portion of Daycare forms to be completed and dropped off at our office for a nurse or provider to complete! This general daycare form is taken by 99% of daycares in the state.
School Physical form Grade
7-12
The Parent Portion of this form is to be completed and dropped off at the office for a provider to complete.