Pediatrics South

Form Completion
Do you need to obtain records from a previous office? Print out a Records Request form and send it to your previous doctor so that we can have the most complete medical records for your child. Records Release to Mt Lebanon Office Records Release to Peters Township Office Records Release to Robinson Office If you prefer to print out your Registration Forms to bring with you to the office, you can do this here: Registration Form Confidentiality Form Financial Policy Form PA State Immunization Form (one per child) Consent for Treatment Form Sport, Camp, and Daycare Forms; We will complete any sport, camp or daycare form as long as the yearly physical is current and meets the requirements of the form. There is a small fee of $5.00 per form for the form completion unless it is completed during the annual physical. Please allow us 3-5 days to complete your form. A form that is required on the same-day is $10.00 per form. Please be aware that WPIAL requires that physicals are completed after June 1st, which will then be valid for the entire following school year. Keep in mind that your school or sports organization may require more frequent physicals. Always check with your athetic director or principal or the PIAA website for current requirements. Pennsylvania Interscholostic Athletic Association In order to completed a *DRIVERS LICENSE FORM, the child MUST BE PRESENT to meet with the doctor briefly. An appointment is not necessary. There is a $10.00 charge for the completion of this form. (*click above to link to form to print out bring with you) If the yearly physical does not meet the needs of the form, a mini- physical can be scheduled to complete the form. This physical will not be submitted to the insurance company and there will be a $30.00 charge due upon the time of the visit. If you are in need of a copy of a school or sports form, you can check the “links” section of our web site to download a copy to bring with you!

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