PennCare for Kids New Patient Forms and Referrals

New Patient Forms

Complete these forms before your first visit and save some time while you're here.

• Patient Registration
• Pediatric Health Assessment

Assessment Forms

• Vanderbilt ADHD Diagnostic Parent Rating Scale
• Vanderbilt ADHD Diagnostic Teacher Rating Scale

Additional Forms

• Non-Commercial Learner's Permit Application
• PIAA comprehensive initial pre-participation physical evaluation

Referrals

Most health care plans require a referral from the pediatrician for children who need so see a specialist. If you need a referral, please call the office and 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