Beginning September 1st 2020, POD will be charging $10 per camp form and or school form, if the form is not completed at the well child exam. If the patient form is dropped off or emailed and asked to be completed the same day, the charge will be $20 per form.

Camp and School Forms

We will gladly complete these forms for you. In order to do this, your child should have a well child visit within the past 12 months. Visits for an illness address a specific problem and are not ordinarily comprehensive enough for us to complete these forms. There is no charge for completing these forms, but please allow us 48 hours.

How can you get the forms to us?

You can mail, fax to 214-691-1044, drop it off at the office, or upload by clicking on the tab 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.

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.

Just need a shot record?

If you need a copy of your child's shot record, email your request to This email address is being protected from spambots. You need JavaScript enabled to view it.. Please put your child's name in the subject line and in the body of the message include their date of birth and the preferred method of returning to you. We can mail, fax, email or leave at the front desk for you to pick up. We will notify you in 24-48 hours when you request has been completed.