In order to avoid delays in completing your child’s form, parents must complete their portion of the forms, including name, date of birth, allergies, medications, medical history.
If sent electronically, forms must be sent as a PDF. Photos do not print clearly.
Turnaround time is usually fewer than 7 business days. Forms are done in the order that they are received.
Forms require a current physical examination.
If a form needs to be dated prior to a full year from the last physical examination, a mini-physical examination can be done. For example, football/cheer forms typically require date of current year for clearance. This type of visit is subject to co-payment/co-insurance.
Paper copies are held for 30 days. If original forms are needed, back please let our staff know prior to form completion.
Physical Forms given at the time of a well exam have no fee.
Forms submitted anytime after a well exam, a $10 fee applies since a chart review is necessary.
Specific Forms
Allergy Action Plan – should be completed by allergist, if managed by one . A $5 fee if completed by our office if no allergist is managing allergy.
Asthma Treatment Plan – should be completed by allergist/pulmonologist, if managed by one . A $5 fee if completed by our office if no specialist managing asthma
School Medication Forms -$5 fee
FMLA - $25 fee
Letters written by physician - $15 fee
All other forms requiring chart review - $10 fee
Other fees
Expedited Fee (1-2 business days): Additional $5
Wrong Form Fee: $10 fee (if form needs to be redone due to wrong form submitted to our office)
