Primary Care, Chestnut Hill

Health Form Requests

The following are guidelines for when you request a health form:

HIPAA laws require written authorization for completion of all health forms.
The Prompt Pay Discount allows practices to apply a 20% discount to our charge for services rendered that are not covered by their insurance plans. This does not include co-payment or deductible obligations.
Your health forms will be completed between 7 to 10 business days upon receipt of $10 each ($12.50 before Prompt Pay Discount) with a maximum of $30 ($37.50 before Prompt Pay Discount) per submission. Forms may be picked up during office hours or mailed to your home. A well child exam must have been completed within the last year.
There is a $20 rush fee ($25 before Prompt Pay Discount) for a form to be picked up within 24 hours. If we receive a rush form on Friday afternoon or Saturday it will be completed on Monday.

Call Chestnut Hill

7700 Germantown Avenue

Philadelphia PA, 19118

215-247-0663

Main Number: 215-590-1000
Physician Referral Service: 1-800-879-2467
Coordinates: 39.9486937, -75.1929596
An Equal Opportunity Employer
The Children's Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, sexual orientation, age, religion, national or ethnic origin, disability or veteran status.