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 physical 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.

The form fees are as follows:

Most forms, such as sports forms, school physical, & day care forms are a $10 flat fee. Please allow three (3) business days for completion.

FMLA forms require extensive chart review & time for completion. These are charged a $30 flat fee. Please allow five (5) to seven (7) business days for completion.

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

**Certain forms will not incur a fee for completion. These specifically include: Head Start forms, WIC forms, Medication forms, Governmental agency disability forms, health assessment forms requested by a specialist, and/or forms for participation in Special Olympics, Make-a-Wish or similar activities.**