Applications and Forms

The St. Mary’s County Health Department is currently closed to walk-in clients. Appointments are available for select services and community members may contact the office for more information. Forms can be printed, completed in advance and brought to your appointment or sent to SMCHD via email, mail, or fax.

Requests for Vital Records

• Birth Certificates
• Death Certificates
• Free Maryland Vaccination Records

Health Clinic Forms

• Patient Sign-In Form
• HIPAA Confidentiality Form

Environmental Health Applications & Forms

• Food Service Annual Operating License Packet
• Mobile Unit Reciprocity License Application
• Application for Individual Sewage System
  • Septic Replacement Drawing
• Application for Outdoor Music Festival
• Application for Burning Permit
• Application for Swimming Pool Operating Permit
• Plan Review Application Packet
• Septic Repair Perc Application
• Temporary Food Service Facility License Packet
• Grant Application for Nitrogen-Reducing Pretreatment Units for Septic Systems (Bay Restoration Fund Grant Program)
• Water Sample Request
• Appeal Process: Well, On-Site Sewage Disposal, Subdivision, and Shared Facility Decisions

Other Forms

• Freedom of Information Act (FOIA) – Public Information Request Form
• Customer Satisfaction Survey [Encuesta de Servicio al Cliente]
• Community Health Complaint
• Health Provider Reporting Form