Whether your child is entering daycare or school, or wants to participate in organized recreational activities, you may be asked to fill out a health form detailing your child’s medical history.
At The Children’s Hospital of Philadelphia and the CHOP Care Network, we are happy to help you get the medical records you need, when you need them.
In most cases, your child must have been seen at a CHOP Care Network location for a complete check-up within the past 12 months for us to complete these forms. If this is not the case, you will need to schedule an office visit for your child.
Health forms are completed at the time of your child's physical exam. Please remember to bring the forms to your child’s visit. Your child’s provider will print a health form (including immunizations) at the time of your child’s well visit. This form can be copied and used throughout the year.
If you need a health form completed at a different time, a $5 fee will be charged. Please allow 10-14 business days after payment for these forms to be completed.
If you need a health form in a hurry, we will do our best to accommodate you. There is a $20 rush fee for a form that needs to be picked up on the same day. No rush orders will be accepted on weekends or holidays.
- Child Health Report (PDF) — used by most PA daycare centers
- PIAA Comprehensive Initial Pre-Participation Physical Evaluation (PDF)
- HIPAA English (PDF) — Authorization to release/obtain information
- HIPAA Spanish (PDF) — Authorization to release/obtain information (en Español)