Lowndes County, GA · Lowndes County
DUI Court Doctor Visit Form
This form records a Lowndes County DUI Court participant’s doctor visit, including the complaint, diagnosis, prescribed medications, and signatures.
At a glance
- Issued by
- City of Lowndes County · Lowndes County, Lowndes County, Georgia
- Notarization
- Not required: file this form without a notary.
- Official source
- lowndescounty.com
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The form documents a doctor visit for someone participating in the Lowndes County DUI Court as a condition of a probated sentence. It asks for the visit date, participant and physician names, complaint, diagnosis, and prescribed medications, and includes signature lines for the doctor or nurse and participant. The form also notes the court’s restriction on mood-altering narcotic substances.
Who needs it
A Lowndes County DUI Court participant who has a doctor visit and the doctor or nurse completing the visit information can use this form.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This document is signed without a notary; the doctor or nurse and participant sign it, and the form includes a date field.
How to submit this form
- 1
Download the Form
Download the Lowndes County DUI Court Doctor Visit Form.
- 2
Complete the Visit Details
Enter the date, participant and physician names, complaint, diagnosis, and prescribed medications.
- 3
Sign the Form
Have the doctor or nurse and participant sign the form.
- 4
Submit to the County
Submit it to the county department named on the form; check the county website for current contact details.
Frequently asked questions
- What information does the Doctor Visit Form ask for?
- It asks for the date, participant’s name, physician’s name, complaint, diagnosis, and prescribed medications. It also has signature lines for the doctor or nurse and participant.
- Who uses the Lowndes County DUI Court Doctor Visit Form?
- The form is for a person participating in the Lowndes County DUI Court as a condition of a probated sentence, with visit information and signatures from a doctor or nurse and the participant.
- Do I need a notary for the Doctor Visit Form?
- No. The document has signature lines for the doctor or nurse and participant, plus a date field; it does not include a notary block.
- How do I submit the Doctor Visit Form?
- The form does not state how to submit it. Submit it to the county department named on the form and check the county website for current contact details.