Looking for Environmental Health Forms? Visit your county’s page to get the correct form for your county.

Print and fill out forms ahead of time for faster service at the health department.

Dental Applications

If you are pregnant, please bring with you to your appointment the Attestation of Pregnancy form.

Dental Application Form
Return completed application forms to the County Health Department.

Heard County Health Department
1191 Franklin Parkway
Franklin, GA 30217

Lamar County Health Department
100 Academy Drive
Barnesville, GA 30204

Forms for providers

All Georgia physicians, laboratories, and other health care providers are required by law to report patients with specific diseases. Both lab-confirmed and clinical diagnoses are reportable within the time interval specified on the NOTIFIABLE DISEASE/CONDITION REPORTING poster. Reporting enables appropriate public health follow-up for your patients, helps identify outbreaks, and provides a better understanding of disease trends in Georgia.

Reporting of diseases may done through our web-based electronic disease reporting system, SendSS (State Electronic Notifiable Disease Surveillance System). You may also print the GEORGIA NOTIFIABLE DISEASE/CONDITION REPORT FORM below and fax it to our office at 706.845.4350.

Download
GEORGIA NOTIFIABLE DISEASE/CONDITION REPORT FORM
Please fill out completely and fax to 706.845.4350.
notifiable report form.pdf
Adobe Acrobat document [604.9 KB]