Forms & Policies
Due to the time involved in the increasing number and complexity of forms that we are requested to complete, there is now a $10 fee for form completion. A form for school, sports or camp will be completed within 3 business days provided your child has had a complete physical examination within the past year. There may be an additional fee if you need the form completed in less than 72 hours. Forms may be picked up when ready or we can mail them to you with a self-addressed stamped envelope.
On each of the form pages please make sure to enter your child’s first and last name and date of birth.
If you require a New Jersey State Universal form (age 11 and up), we need to have the completed Part A questionnaire, as we must review it when we complete Part B (the Physical Form). If you need a copy of this form, it can be downloaded from our website.
- Universal Child Health Care Record
Please bring this form with you for Grades K through 5 .
- Athletic Pre-Participation Physical Examination Form
Please print out this form and complete the History (Part A) before you bring your child for a physical exam. (6th grade and older)
- Record Release Form to send records to Middletown Pediatrics
- Record Release Form to send records to another doctor or hospital