Form Requests (Not Sports Related)

We are happy to complete forms for your child.** Your child needs to be up to date with their age appropriate physical exam. Some organizations do require that your child have a more recent exam.*** If this is the case, we will let you know. There is a $10.00 fee for all forms not requested at the time of the annual well check. Forms requested at the time of the annual check will be completed at no charge.

To process your request we will need the following:

  • A copy of the form from the organization requesting clearance. We do have the Pennsylvania School Forms (needed for Kindergarten, 6th and 11th grades). We also have the Child Health Form (for day care). You will need to provide us with the form for any other requests.
  • We will need to know if you want to pick up your completed form or have it pushed to your patient portal account. (Instructions to retrieve your portal form can be found here)

Please note that while we accept forms via fax or drop off, no forms will be able to be completed unless all information is present. At this time, forms cannot be requested via the portal.

Most forms will be completed in 1-2 business days.  If you have requested your form be pushed to your patient portal and you do not see it after 2 business days, please call the office and choose the option to speak with the nurses.

** Some schools include the sports clearance as a part of their school form.  If your form includes this, even if your child is not currently planning to play sports, please follow the Sports Clearance Forms Instructions.

***If you are requesting a Drivers License form for your child, please note the following:

  • You child and a parent or guardian need to schedule an appointment with the office unless the form is requested at the time of the child's annual physical.  We do not fill out these forms without the child and parent/guardian being physically present in the office.
  • The form cannot be completed unless the physical exam was done within 6 months of the form being turned into the state. If your child's visit was more than six months ago, but they are not yet due for their annual exam, please call the front desk for more instructions.

Is Your Child Sick?®