Health Form Requests: CHOP Campus

Whether your child is entering daycare or school, or wants to participate in organized recreational activities, you may be asked to fill out a health form detailing your child’s medical history.

At Children’s Hospital of Philadelphia and the CHOP Care Network, we are happy to help you get the medical records you need, when you need them.

In most cases, your child must have been seen at our CHOP Care Network location for a complete check-up within the past 12 months for us to complete these forms. If this is not the case, you will need to schedule an office visit for your child. Sports clearance forms must include a sports clearance evaluation (separate from the annual visit) after June 1 of the current sports season. 

Health forms are completed at the time of your child's physical exam. Please remember to bring the forms to your child’s visit. Your child’s provider will print a health form (including immunizations) at the time of your child’s well visit. This form can be copied and used throughout the year.

If you need a health form completed outside of an office visit, a $10 fee will be charged per health form if paid at the time of request, up to $30 per family.  Forms paid for at the time of pick-up will be assessed a fee of $12.50 per form, up to $30 per family. Please allow five to seven business days for forms to be completed.

If you need an expedited health form, there is a $25 fee. The form will be completed within 24 hours. If we receive an expedited request on Friday afternoon or Saturday, it will be completed by the close of business on Monday.

Please note: HIPAA laws require written authorization to send any health information outside of the institution.

Downloadable forms

Daycare/School

Sports

General

  • HIPAA English (PDF) — Authorization to release/obtain information 
  • HIPAA Spanish (PDF) — Authorization to release/obtain information (en Español)