Patient Forms

Our patient forms are here for you should you ever need them. However, we have invested in new technology to improve our check-in process, saving both time and paper. Instead of being given a clipboard with several paper forms to complete, you will now have the ability to complete registration electronically through Phreesia. 

Letter/ Forms Completion

We will gladly fill out the required forms for your child at his or her well checkup at no charge. However, if you need any forms/ letter completed outside of your scheduled well-child appointment, there will be a fee per child. The Carithers Pediatric Group reserves the right to modify these charges from time to time at our discretion. If a type of form presented for completion is not included in this list, we reserve the right to apply a fee that we deem appropriate.

Daycare/ School forms, WIC Forms: $5.00
College forms, Sports/Camp forms, and Overseas/Travel forms: $10.00
FMLA/ Disability forms: $20.00

Proudly Serving Children in Two Locations


2121 Park Street

Jacksonville, FL 32204



7741 Point Meadows Drive, Suite 207

Jacksonville, FL 32256