For your convenience we have available the forms you will need to fill out prior to
your first visit. Also there is a form for Patient Information to read prior to your
appointment. Please select all that apply, click below on the applicable forms,
download, print and fill-out.
LCC Patient Info.pdf
LCC Adult Medical History.pdf
LCC Children’s Medical History.pdf
LCC Patient Financial Application.pdf
The Cedar Rapids Community School District physical form must be filled out by a
physician, signed by a parent and turned into the respective school to participate in
sports in middle and high school.
School Physical Revised 1-12-09.pdf