Forms Financial Policy

We encourage you to bring any applicable forms that require a provider’s signature with you to your child’s yearly physical examination so we can complete them at no additional cost to you. Please ensure that you complete all components of that form prior to your child’s arrival at our office. Examples: school, camp, sports, pre-school, medication administration forms.


If the necessary forms are not presented at the time of the yearly physical exam but rather brought in or mailed to our office for completion after that visit, you will be subjected to a $20.00 administrative fee for each form required for your child(ren). If you need the form(s) in less than 72 hours, the charge is $20 for each form PLUS an extra $25 rush fee for the form(s). For example, if a family is requesting 3 forms for 3 children with a rush request, the total charge is $60+$25 = $80 Total for forms.  This/these fees will be due prior to pickup of the completed forms. If you are requesting that our office mail your child’s form back, you will need to send payment along with that form. Please be aware that these fees are not covered by your medical insurance policy.