Form Fees

Please bring all necessary forms to your child's well visit for completion. Completing physical forms requires a significant amount of time for our nurses and physicians. Therefore, if forms are submitted to us more than one (1) month after the exam date, there will be a charge per form. Forms presented at the time of the physical exam, with the exception of Family Leave (FMLA) are free.

Effective 7/1/12, the form fees are as follows:

Work Permits $5.00

Family Leave (FMLA)  $25.00

All Other  $10.00

Please be advised that this is a non-billable service and payment is due as services are rendered.

Last Updated on Thursday, 06 October 2016 19:25

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Offices open at 8 a.m.,
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Patients are scheduled by appt.


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Mon-Fri 2:30-4:30 PM

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300 Brighton Avenue
Rochester, PA 15074
Fax: 724-774-7394

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701 Broad Street, Suite 422
Sewickley, PA 15143
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119 VIP Drive
Wexford, PA 15090
Fax: 724-935-9644
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119 VIP Drive
Wexford, PA 15090
Fax: 724-935-0331
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