Boys and Girls Club - Dover Club
2801 Dover Park Dr.
Dover, FL 33527
XXX-XXX-XXXX
En Español
Visits cannot be scheduled online right now.
Welcome to Boys and Girls Club - Dover Club!
By providing the information below we will hold a spot for your child's visit. Please provide a good contact number. The Mobile Medical Clinic will contact you to finalize your appointment scheduled and documents required at the time of the visit.
Please select an appointment type and provider to see available times
1. Please select appointment type and provider
Select a reason:
Immunization Only
Physical
Visit Time is required.
Please select appointment time
<- Earlier Dates
Later Dates ->
Please fill out rest of the information
2. Please fill out rest of the information
Please fill in additional patients.
Patient First Name
Patient Last Name
Cell Phone Number
Date of Birth
Gender
---
Female
Male
Patient's street address
Patient's City
Patient's State
Patient's Zip Code
Cell Phone Number
Patient's Email Address
Race
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Amer. Indian/Alaskan Native
Asian
Black/African American
Hawaiian/Pacific Islander
Other
White
Ethnicity
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Hispanic or Latino
Not Hispanic or Latino
Preferred Language
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English
Spanish
Portuguese
Russian
Other
Insurance
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Yes - Enter insurance in field below
No - Leave insurance field blank
Insurance Name
Enter Child's Doctor name if they have one
Notes
Parent Name
We'll send you a text message when it's time to show up.
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