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Florida Department of Health in Lee County
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Home / Programs & Services/ Clinical and Nutrition Services / Forms for Clinic Appointments

Forms for Clinic Appointments

English

  • Things to bring to your screening
  • Client Eligibility Registration Form
  • Health Insurance Application for Extended Family Planning Benefits

Spanish

  • Aviso sobre Normas de Privacidad DH150742
  • Solicitud para Seguro de Salud Para Beneficios Extendidos de Planificación Familiar

Creole

  • Avi Sou Practik Konsènan Lavi Prive DH150743
  • Aplikasyon asirans medikal pou ekstansyon benefis plannin familyal

Save time! Have your forms completed when you arrive.

Programs & Services
  • Clinical and Nutrition Services
    • Eligibility Requirements
    • Family Planning
    • Florida Breast and Cervical Cancer Early Detection Program
    • Forms for Clinic Appointments
    • Immunizations Services
      • Adult and College Students Immunizations
      • Child Immunizations
      • School Immunizations
        • School Enrollment
      • Travel Immunizations
    • Insulin and Epilepsy Prescription Assistance
    • Refugee Health Program
      • Refugee Health Program FAQ
      • Refugee Health Program Services
    • Women, Infants and Children Nutrition Program (WIC)
      • Breastfeeding Program in Lee County
      • Florida WIC App
      • Moving with WIC
      • Other Helpful Programs
      • Using WIC Benefits

Clinic Appointments

Phone: 239-461-6100

Phone: 800-342-3556 (WIC)

TTY users can contact us through Florida Relay by dialing 7-1-1 or one of the other Relay Toll Free Numbers. 

Michigan Clinic
3920 Michigan Ave. 
Fort Myers, FL 33916

Pondella Clinic
83 Pondella Rd.
Fort Myers, FL 33916

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Led by the State Surgeon General, the mission of the Florida Department of Health is to protect, promote, and improve the health of all people in Florida through integrated state, county, and community efforts.
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