Patient Forms

We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.

In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.

Permission to Treat Forms: If a person other than a parent is bringing a child to the office, we need written permission to treat the child. Please ask for the form at the desk if your child is routinely with a grandparent or other caregiver.

Other Forms: There is a $10 charge for all forms unless the form is filled out during a well check appointment. This must be paid at the time the form is given to the office for completion.  A pre-sports screening form must be filled out by a parent only before the doctor can complete any sports form.  The forms will be ready for pick-up 24 hours after delivery to PPA, Monday through Friday only.  Please pick up your completed forms at the front desk.

  • SPORTS FORMS -- For PIAA forms, the patient must have a well check after May 1st for participation in sports for the upcoming school year.
  • HEALTH APPRAISAL FORMS -- The patient's last well check must be within the past year.
  • COMMUNITY SPORTS -- The patient's last well check must be within the past year.