Health Form Requests
- If you have already scheduled your well child visit (physical exam) and have a form that needs to be completed, there will be no additional charge for the form if presented at the time of the visit.
- There is a $10.00 cash payment ($12.50 before Prompt Pay Discount) for all health forms to be completed regardless of the number of forms presented at that one time. If an additional form is needed later, another $10.00 fee will be charged. Your form(s) will be completed in 3 business days upon receipt of payment for the form.
- There is a $20.00 cash payment ($25.00 before Prompt Pay Discount) for a sports form that is needed the same day. The form must be received in the office (weekdays only) by noon in order for it to be completed by 3 pm that day.
- Driver’s Permit Physical Examination forms can be completed as long as the teenager has had a physical exam within six months of their 16th birthday. That physical examination is good for one year. Please note that driver’s forms need to be signed by the patients in front of a staff member.
- There is no charge for completing medication dispensing forms or for copies of immunization records.
- As long as your child has had a well PE within past 12 months, we are able to complete most forms (i.e. School, sports) based on that PE.
- Pennsylvania driver's permit forms require that the PE be done within 6 months of your child turning 16 and the PE is good for one year.
Authorization to Release Medical Records
Central Bucks Schools - Medication Dispensing Form
Day Care Form
Interim Health Form
School Health Form