School/Sports/Day-care Forms

School/sports/daycare/camp forms will be completed free of charge at the time of a well visit. Please complete all of the parental sections of forms prior to presenting to our staff. Forms can be completed at other times for a $10 fee with a turn around time of approximately 3 business days. 

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.

Commonly Used Forms:

Medication Dispensing Forms by School District:


My Kids Pediatric Partners, PC

1102 Highway 315 Blvd, Wilkes-Barre, PA 18702

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