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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05/10/21:  Pfizer COVID vaccine approved for EUA in kids 12 and older




 FAQ from our Providers


IDPH COVID-19 Isolation and Quarantine Guidelines

IDPH Isolation Quarantine 10.23.20
Release Isolation+Quarantine Release Gra
Adobe Acrobat Document 183.5 KB



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


Required Vaccines for IL Schools
Adobe Acrobat Document 180.9 KB