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

Referrals

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