A Note to Parents:

Please complete patient and parent information on forms prior to handing to our staff. We process large numbers of forms and want to make sure the information is appropriately entered. Many times outside entities will accept our standard school/camp form which can be printed and provided free of charge at your child's well visit. Forms can be completed at other times for a $10 fee with a turn around time of approximately 3 business days. Ask us to print a form during your visit so that you can have it on hand in anticipation of future needs.

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Commonly Used Forms:

• Pennsylvania School forms (mandatory for grade K, 6 and 11)

• Pennsylvania Standard Daycare Health Assessment form

• PIAA Sports Participation forms (MUST COMPLETE PARENT SECTION 5 HEALTH HISTORY PRIOR TO DROPPING OFF AT OUR OFFICE)

• Boy Scouts of America Camp Form

• Pennsylvania Lerner's Permit Application

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Medication Dispensing Forms by School District:

• Crestwood

• Bear Creek Charter School -unavailable

• Dallas

• Hazleton

• Lake Lehman-unavailable

• Nanticoke

• Northwest

• Pittston Area

• Wilkes-Barre Area- unavailable

• Wyoming Area-unavailable

• Wyoming Valley West​

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• Abington Heights

• Dunmore 

• Old Forge

• Riverside

• Scranton Area-unavailable

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