PBCHD
Organizational Chart
(*.pdf)

PBCHD Public Service Events Calendar


Brochure
of Services
 

Vital Statistics Request Forms
(Birth & Death Certificate) 

Birth Certificate Request Forms: 

• Application for a Florida Birth Record   39 k

Death Certificate Request Forms

• Application for a Florida Death Record  105 k

Registration/Eligibility  & Assessment Forms

English Registration/Eligibility  & Assessment Forms
Please complete and bring this form(s) to the health center, if you
have a doctors appointment. Please do not mail in.

• Healthcare Registration/Eligibility-Part 1 Form (English)
• Healthcare Assessment Part 2. (English)

Creole English Registration/Eligibility  & Assessment Forms
Tanpri rampli fòm (sa) (fòm yo) épi tou poté’(l) (yo) nan dépatman santé piblik la. Si ou gen apwentman doktè tanpri pinga posté’ (l) (yo)

• Healthcare Registration/Eligibility-Part 1 Form (Creole)
• Healthcare Assessment Part 2. (Creole)

Spanish English Registration/Eligibility  & Assessment Forms
Por favor llenar y traer este formulario al Centro de Salud si usted tiene una cita medica. No lo envie por correo.

• Healthcare Registration/Eligibility-Part 1 Form (Spanish)
• Healthcare Assessment Part 2. (Spanish)

Environmental Health & Engineering permitting forms

Link to Environmental Health & Engineering permitting forms

• Public Water Supply and Wastewater Systems
   
• Septic Tanks (OSTDS) and Private Drinking Water Wells
   
• Solid, Hazardous & Biomedical Waste Control
   
• Public Swimming Pools
   
• Child Care
   
• Family Day care Rules & Regulations
   
• Body Piercing
   
• Air Quality
   
• Food Hygiene License

Publications

Visit the Publications page

• Publications
   

Newsletters

Visit the Newsletter page

• Newsletters