Primary Care, West Chester

Health Form Requests

The following are guidelines when requesting a health form:

HIPAA laws require written authorization for completion of all health forms.
There will be a $10 charge for all health forms completed outside of a routine physical examination. Forms competed outside of a routine examination will be completed and mailed or ready for pick up in 7-10 business days.
There is a $15.00 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.
If you have already scheduled your well child visit (physical exam) and have a form that needs to be completed, the cost of that first form will be included in that day's copay. There will be an additional charge for each form.

Call West Chester

440 East Marshall Street
Third Floor North, Suite 300

West Chester PA, 19380

610-436-1193

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.