Health Form Requests
Effective April 1, 2010
The following are guidelines when requesting a health form:
- At your scheduled well child visit (check-up) if you have a form that needs to be completed, there will be no additional charge for the form that is done at the time of the well visit. Please remember to bring forms along at the time of your scheduled visit.
- Your provider will print a health form (including immunizations) at the time of your well visit. This form can be copied and used throughout the year.
- There is a $5.00 cash/check payment for all health forms to be completed regardless of the number of forms presented at one time (per child). If an additional form is needed later, another $5.00 fee will be charged. Your form will be completed in 2 – 3 business days upon receipt of payment for the form.
- There is a $20.00 fee for a form that needs to be picked up on the same day. No rush requests will be accepted on a Saturday.
- Please remember that a well child exam must have been documented within the last year in order for your form to be completed.
Contact Us
Call Coatesville
- 610-384-9500
- Do you need a same day sick appointment or have an urgent question? Please call the office, rather than contacting us online.
- Contact Us Online
- Request an Appointment
Our Address
495 Highlands Boulevard
Suite 100
Coatesville PA, 19320-5808
Fax
610-384-3998