Your Visit > Forms

Forms & Policies

Our PAK staff will complete your  physical form free of charge during your yearly well visit. All forms must be given to the CCS when in the room for your appointment; only forms presented in the room  will be processed at the time of your appointment.

Additional forms or forms brought to our offices during normal office hours will be completed within 1-2 days for a $15 service fee.  For us to complete a form, your child’s well visit must have been within the time frame recommended for his or her age: within the last 12 months of school-aged children, or shorter intervals for younger children.

Here are some common forms used by PAK patients and families. Just click on the links for PDF copies you can download, print, begin to fill out, and bring to our offices for your next visit:


Back To School

Welcome Packet


Health Forms


New Patient


Is Your Child Sick?TM

425 Tioga Avenue | Kingston, PA 18704 | Phone: 570-288-6543
1081 Oak Street | Suite 1 | Pittston, PA 18640 | Phone: 570-602-PAKP
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