Forms & Brochures

Forms

The following forms are here for your convience. 

Download, print and complete the following forms as instructed by your PanCare  provider.

 


Bay District School Health Consent Form

 

Complete this form for MEDICAL OR DENTAL services prior to your first visit to our clinic.
English Version        Spanish Version

MOBILE UNIT Form (PDF):  Complete this form prior to being seen on our medical or dental mobile clinics. 

Updated Patient Health Information Form:  Complete this form when your health information needs to be updated.

Living Will - Florida

Five Wishes

Health Care Surrogate - Florida

Power of Attorney - Florida

Brochures

 

What is a Patient Centered Medical Home? (ENGLISH) (PDF)

What is a Patient Centered Medical Home?  (SPANISH) (PDF)

PanCare DSME Brochure