Progressive Family Care

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Our goal is to provide you and your family with quality care and service. That's why our friendly staff works to minimize paperwork and make it more convenient for you. For your convenience many of our patient forms are below. To save time, you may print and fill out these forms prior to your first visit and bring the completed forms to your first appointment.

PRIMARY CARE FORMS

Please click on any of the following applicable form(s) to download and fill out prior to appointment:

  • State of Illinois Certificate of Child Health Exam (Daycare:School Form)
  • IHSA Pre-Participation Exam (Sports Participation Form)
  • School Medication Dispense Form
  • Handicap Sticker Form
  • Living Will
  • DNR
  • POA
  • Workman’s Compensation Form
  • EGD Procedure
  • Colonoscopy Prep

PEDIATRIC FORMS

Please click on any of the following applicable form(s) to download and fill out prior to appointment:

  • State of Illinois Certificate of Child Health Exam (Daycare/School Form)
  • IHSA Pre-Participation Exam (Sports Participation Form)
  • School Medication Dispense Form
  • Ear Piercing Form



 

VACCINE INFORMATION STATEMENTS (VISs)

Vaccine Information Statements (VISs) are information sheets produced by the Centers for Disease Control and Prevention (CDC) that explain to vaccine recipients, their parents or their legal representatives both the benefits and risks of a vaccine. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given. For more information, visit the CDC. Click on the vaccination name to download the VIS:

  • DTaP
  • Hepatitis A
  • Hepatitis B
  • Hib
  • HPV (Gardasil)
  • MMR
  • Meningococcal
  • Polio
  • Pnuemo Vac (Prevnar)
  • Rotavirus
  • Tetanius with Diphtheria and Pertussis
  • Varicella
  • Combination Immunization Given to Infant





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For Patients
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208 N. Main St. Suite H
Columbia , IL 62236
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208 N. Main St. Suite H Columbia , IL 62236

Copyright © 2019 Progressive Family Care All rights reserved.

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  • For Patients
  • Clinic Visit
  • Patient Portal FAQs
  • Procedure Preparation
  • Services
  • Providers
  • FAQ
  • About Us
  • Find Us
  • Contact Us