Physical Exam, Immunization, and Medication Forms

Daycare, School, Medication Administration, and Camp Forms can be requested via email.  We can complete the standard DCFS Exam form from your child's last well child exam provided that he or she has had a physical exam within the past 12 months.  PLEASE NOTE:  Some schools require that a physical exam be completed no more than 6 months prior to enrolling in school or participating in athletics.


Medication forms must be obtained from the school and completed with as much information as possible prior to being signed off by your child's primary care physician.  You can fax these forms to our office and will be notified upon their completion.

Note: Please fill out the fields marked with an asterisk.

P: 847-658-6065

F: 847-658-6136


301 N Randall Rd

Lake in the Hills, IL 60156

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Masks will be required in our office should McHenry County COVID community levels become HIGH





Open Letter to Parents
VPS 1.1.16.pdf
Adobe Acrobat Document 136.6 KB


Required Vaccines for IL Schools
IL immunization reqirements 2021.pdf
Adobe Acrobat Document 171.3 KB