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 --> www.cardinalpediatrics.com/schedule 

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!