Primary Care, Flourtown

Health Form Requests

The following are guidelines when requesting a health form:

Please bring your school or camp form with you on the day of your well visit. It will be completed at that time, free of charge.
There is a $10.00 charge for all health forms not completed on the day of the well visit. Your form will be completed within 7 to 10 business days.
There is a $20.00 rush fee for a form that needs to be picked up in 24 hours. If we receive a rush form on Friday afternoon or Saturday, it will be completed on Monday.
Please remember that a well child exam must have been documented within the last year in order for your form to be completed.

Call Flourtown

1811 Bethlehem Pike
Suite A106

Flourtown PA, 19031

215-836-2705

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.