The following are our guidelines when requesting a health form:
At your scheduled well-child visit (check-up/annual physical), 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 five business days upon receipt of payment for the form.
There is a $25.00 fee for a form that needs to be completed within 24 hours. 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.
The Pennsylvania Interscholastic Athletic Association (PIAA) requires all athletes to have a physical exam after June 1 for completion of the PIAA sports clearance form for the following school year.
Driver’s Permit Forms – a physical needs to have been done within six months from the child’s 16th birthday (Pennsylvania Law). See link below.
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.