Please complete the parent portion and bring a copy to your visit for completion. These can be filled out at your child's well child visit or a sports physical visit.  Sports Physical visits are $25.00 and must be paid upfront.  

If you have a current well child visit (less than 6 months), we can email the form back to you. 

To schedule a Well Child Visit online --> 


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WV Sports Physical Form WV Sports Physical Form


Most insurances allow one well child check per year for ages 3 and older, however, there are some exceptions: 

  • PEIA's calendar year runs from July 1 to June 30th  
  • Some Aetna plans only allow 1 visits every 365 days

Always check with your insurance benefit plan to see what they will cover!