PennCare® for Kids

Forms & Requests

New Patient Forms

Completing the following forms beforehand will save time because patients will not have to complete these forms while in the office.

Assessment Forms

Additional Forms


Should a patient need to see a specialist, most managed care plans require a referral from the pediatrician. When a referral is needed, please call the office and press #5. Callers should have the following information ready when calling:

  • Child's first and last name
  • Child's date of birth
  • The name of the specialist the child will be seeing
  • The test or service the child will be having
  • The diagnosis (why the child is seeing the specialist)
  • The date and time of the appointment
  • Number of appointments needed
  • The name of patient's insurance company and the insurance ID numbers