DOCTORS PROVIDING HEALTHCARE FOR CHILDREN AND ADOLESCENTS TO BUCKS COUNTY, PA – PEDIATRIC SERVICES


FORMS

Medical Release

New Patient Form

PIAA COMPREHENSIVE INITIAL PRE-PARTICIPATION PHYSICAL EVAL

Refill Request Form

Referral Request Form

All patient forms require at least five business days to be completed and there is a $10.00 charge for them.

Form PA 586 (Report of Physical/Mental Examination) requires at least five business days to be completed.

Health forms can only be completed if your child has had a well visit within the last year.

Patients requiring a sports participation form to be completed must complete or have their parents complete Section 3: Health History of the PIAA CIPPE form.  

Referrals:
  • Referrals require at least two business days to be completed. Fracture care referrals are exempt from this policy and will be done within one working business day.
  • Referrals will be completed only if the parent provides all necessary information.
  • Referrals will only be faxed to a specialist if that specialist does not have Internet access.
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