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310 E. Torrance Ave., P. O. Box 650 • Pontiac, Illinois 61764 • Phone: 815-844-7174 • Fax: 815-842-2408
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Home » Forms

Forms

Application for Employment

Consent to Bill

Cornerstone Informed Consent Form

Family Planning

Food Safety

Freedom of Information Request Form

Geothermal Exchange System Construction Report

Geothermal Exchange System Permit Application

Immunization Form Child to Teen (Birth to 18 yrs)

Immunization Form Adult (19 yrs or older)

Privacy Practices & Acknowledgement of Receipt Form

Private Sewage Disposal – Construction Application

Private Sewage Disposal – Commercial Application

Private Sewage Disposal – Existing Disposal Form

Private Sewage Disposal – Homeowners Application & Instruction

Release of Medical Information Forms

School Based Health Center Student Packet

School & Sports Physicals

Surface Water Supply System Permit

Volunteer Application

Water Well Application for Permit to Construct, Modify, or Abandon a Water Well

Water Well Construction Report

Water Well Pump Installation Report Form

Water Well Sealing Plan for Homeowners

WIC Clinic

Women’s Clinic

Recent Posts

  • 2022 School/Sports Physicals & Immunizations
  • Food Sanitation Manager’s Course
  • Increases in Drug Overdose Deaths – Life-saving Narcan Available for FREE
  • Nationwide Blood Shortage – Donations Needed
  • COVID-19 Monoclonal Antibody Therapeutics
  • Free COVID-19 Testing at Heartland Community College Pontiac
  • You Do Not Have to Fight Abuse Alone

Previous Featured News

DISCLAIMER: The LCHD is transitioning to a new website. During this time, current website content may not be up-to-date or ADA compliant. We kindly ask for patience as we create a better site to serve our Livingston County community.

Our current fax number is 815-844-7468.

Our mailing address is 310 E Torrance Ave, Pontiac, IL 61764. We no longer use a PO Box.

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