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Connecticut DCF-357 Physician's Statement, Foster Care

Connecticut DCF requires a physician's statement on the health of people applying to foster or adopt, and the same form serves probate court custodian or guardian applicants and household children. The examiner records exam findings and tests, chronic or psychiatric conditions, hospitalizations, a prognosis, freedom from communicable disease, and whether the applicant's physical and emotional condition is satisfactory for fostering or adopting.

Who completes it

The examining physician completes and signs the statement. The applicant signs the authorization at the top to release the information to DCF, including for a minor child when the child is the person examined.

Submitting and payment

How to submit it
The examining physician mails the report directly to the DCF office and contact named at the bottom of the form.
Who pays
The form sets no fee and does not say who pays for the examination.

Good to know

  • Each question refers to 'the applicant (or child)', so the same form is used for an applicant or for a child in the applicant's household.
  • Connecticut regulations require the physician's statement to cover the twelve months before the application.
  • DCF's numerical form index lists Spanish and French translations of the DCF-357 in addition to the English fill-in PDF.
  • The current edition is DCF-357 3/16 (Rev.), and it asks for blood pressure, chest X-ray, blood serology and urinalysis dates and results.

Get the official form

Download the current version from the source each time; forms change without notice.

Physician's Statement for Foster Care or Adoptive Applicant

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who sends the DCF-357 to DCF?

The examining physician. The form states that the report should be mailed directly by the examining physician to the Department of Children and Families office listed at the bottom, with an attention line and date. It is not meant to be handed back to the applicant to submit.

Is the DCF-357 available in Spanish?

Yes. Connecticut DCF's numerical form index lists Spanish and French translations of the Physician's Statement for Foster Care or Adoptive Applicant alongside the English fill-in version posted on the DCF website.

What does the DCF-357 ask the physician to decide?

Whether the applicant's physical and emotional condition is satisfactory to provide foster care or adopt a child, and whether the applicant or child is free from communicable disease. A no answer to either needs a description. The form also asks for an overall impression of health and a general prognosis.