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 charge for the form if presented at the time of the visit.
- If the forms are not presented at the time of the visit, then a $10.00 fee will apply for the first form and a $5.00 fee for each addtional form.
- Your form(s) will be completed in 7 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.
- There is no charge for completing medication dispensing forms or for copies of immunization records. These can be obtained by contacting the office directly and requesting a copy, and are also available through MyChart.
- A Well Child Exam must have been documented within the last year in order for your form to be completed.
Universal Child Health Record
NJ Department of Education - Pre-participation Physical Evaluation