• Mechanicsburg Office
    Fredricksen Outpatient Center
    2025 Technology Parkway, Suites 108 & 109
    Mechanicsburg, PA 17050
    Phone: (717) 791-2680
    Fax: (717) 791-2686
  • Camp Hill Office
    25 West Shore Drive
    Camp Hill, PA 17011
    Phone: (717) 791-2680
    Fax: (717) 909-6803
FAQs

Forms: What kind do you have?

as of 8/21/2017
 

Forms: What kind do you have?

as of 8/21/2017
 
If you have school, sports, daycare or any other type of form that you need us to complete, please bring it with you to your well child visit. There is no charge for a form completed at your well visit!

If we need to complete a form at any time other than at a scheduled well visit, please see the list below or call our office to determine if an appointment is needed, and if so, what type of appointment. There is a $10 fee for all form visits with our medical staff and a maximum 48-hour turnaround time; our goal is to provide the highest quality medical care and it takes time, attention to detail, and knowledge to complete patient forms. Please make sure that all personal information (required to be completed by a parent) is completed before you arrive for in our office for your visit.

Form visits are not submitted to insurance, so there would be no insurance co-pay for this type of visit.
 
We cannot complete a form if your child has not had a well visit within the past year. In this case, we will schedule a well visit appointment for you as soon as possible, and complete the form at that visit (no charge).
 
School Forms:
These include forms required by your child’s school for the kindergarten, 6th grade, and 11th grade years to prove that your child has had a physical (well visit). If your child has had a physical with us within the last year, usually all that is required is for us to provide you with the “Private Physician’s Report” from that visit. This report contains all of the information that the school requires, including your child’s current immunization record. If you did not request this report at your child’s most recent well visit, please call our office and we will provide this for you at no charge.

College Forms:
These include forms for college admission to prove that your child has had a well visit recently or has received certain immunizations. Please check the information provided to you from the college to see exactly what they require. If your child has had a physical with us within the last year, the “Private Physician’s Report” from that visit may be sufficient. This report will also contain your child’s current immunization record. If you did not request this report at your child’s most recent well visit, please call our office and we will provide this for you at no charge. Sometimes all that colleges require is proof of certain immunizations (i.e. the meningitis vaccine), which we can provide for you. If the college requires a current physical (more recent than your child's well visit within the last year), then you will need to schedule a form visit ($10 fee & maximum 48-hour turnaround).
 
Daycare Forms:
These include forms required by daycare providers or preschools. Most daycare providers require children to have well visits at intervals following the AAP guidelines (see Services > Well Child Visits). If your child is current with his/her well visits, usually all that is required is for us to provide you with the “Child Health Assessment” report from his/her last visit. This report contains all of the information that the daycare provider (or preschool) requires, including your child’s current immunization record. If you did not request this report at your child’s most recent well visit, please call our office and we will provide this for you at no charge.
 
Sports Forms:
These include any type of school or club/community sports program for which the child is required to have a physical in order to participate. If your child has had a physical (well visit) with us within the last year, then all that will be required is a form visit ($10 fee & maximum 48-hour turnaround).  If the child’s last well visit was within the last 30 days, no form visit is required, but the fee and turnaround time will still apply. Keep in mind, many school sports programs require the physical (or form visit) to be done no sooner than June 1st in the summer preceding the school year in which they are participating. (i.e. playing fall soccer or winter basketball in 2017-18 school year, they cannot have the physical before June 1st 2017).
 
Camp Forms:
As there are many different types of camps (summer camps, scouts, sports), it is best to call our office to determine if an appointment is needed. In most cases, if your child has had a physical (well visit) with us within the last year, a form visit ($10 fee & 48-hour maximum turnaround) will be required. If the child’s last well visit was within the last 30 days, no form visit is required, but the fee and turnaround time will still apply.
 
Driver Permit Forms:
The Pennsylvania Learner’s Permit application contains a section that must be completed by the applicant’s medical provider and signed in the presence of that provider. If your child has had a physical (well visit) with us within the last year, then all that will be required is a form visit ($10 fee & 48-hour maximum turnaround).
 
Miscellaneous Forms:
These include forms for volunteer programs, school trips, and any other type of program for which a doctor’s clearance/signature is required. Please call the office.

Mechanicsburg Office • 2025 Technology Parkway, Suites 108 & 109 • (717) 791-2680 | Camp Hill Office • 25 West Shore Drive • (717) 791-2680