​          Documents:    To download and print our Record Release to transfer care to another provider, click HERE.

                                          To download and print our HIPAA Preference form -required for new patients, click HERE.

                                          To download and print our CONSENT TO TREAT form, to designate someone other than yourself

                                           to bring your child to an appointment, click HERE.   

                                           To download and print our New Patient Registration page, click HERE.

                                           To download our PATIENT CONTACT information update page, click HERE.

        FORMS​     Our office is not responsible for reminders of well checkups.  Last minute appointments may not be available.

  • Our office is small and we try pride ourselves on efficiency, however, if your daycare requires that a specific form be completed by hand rather  than using the State approved Daycare forms in our system, there may be a delay in completion.
  • School and Daycare forms can NOT be completed if your child has not had a well check-up within the last year.  We may not be able to accommodate your child's well checkup appointment at the last minute so we ask that you try to remain up-to-date with checkups.  If a school / daycare form was not requested at your child's last checkup and one is needed, there is a $10 fee for the creation and completion of this form.
  • Drivers Forms: If you are in need of a Drivers Form, this may be completed at your child's annual exam, as long as they are at least 15 1/2 year of age.  We do have these forms available, or you may download one from the PennDot site HERE.  There may be other criteria for having a Driver's Form completed. Please call the office for more information.​  ​
  • PIAA Forms Requirements: If your child requires completion of a PIAA form, please remember to complete the Health History portion prior to bringing the form to us.  Also, be sure that you hand us every page of the form.  PIAA physicals are not valid unless the child is examined AFTER  

           June 1st of the current year.  If the well check was before June 1st, a sports physical will be required before completion of the form at an out-of-pocket                cost of  $60.  If you need more information on PIAA Forms and Requirements, please check HERE.

  • Camp Forms and simple Sports Forms:  Must have an up-to-date physical.  Football (non-PIAA) may require a physical in the same calendar year in which the sport is played. Please contact the office to see if this applies to your child.  Stay up-to-date with your child's yearly physical by calling today. 


  • ​ Fee:  There is a $10 fee for any form not presented at the time of a visit. 

Will your child need to be given immunizations?
Most children will receive multiple vaccines at visits during the first year and a half.  Each year, vaccines may be required, however, children who remain on the recommended vaccine schedule without falling behind, typically will not require vaccines at the 2 or 2 1/2, and the 6 through 9 year well checks, other than a possible flu vaccine.  Please note that this is just a guideline since recommendations change.  

Click HERE for more information on which vaccines your child may require.

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Healthy Starts Pediatrics, PC​​​

Where your Child's Health Matters