Wellness Visit and Physical Exam Forms:

Please select the appropriate age and complete all forms. If your child is between ages for forms, select the forms younger than their age.


For example, if your child is 21 months old, complete the 18 month forms.

One Month
Two Months
4 Months
6 Months
9 Months
12 Months
15 Months
18 Months
24 Months
30 Months
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11-14 Years
15 - 18 Years
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For your convenience, we have linked a few school physical forms. If your school or daycare has their own form required, please ensure you bring it to your appointment with your portion completed.

IL School Physical Form

IL Sports Physical Form

Kirkwood Kindergarten School Physical Form

Mehlville School Physical Form

Lindbergh School Physical Form

MO Sports Physical Form

MO Child Health Exam Form (Infant-Preschool)

Fax: 618-281-8393 

PHONE HOURS: Monday-Friday 8:00-4:30,

Evening and Weekend Appointments Available

Evening and Weekend Appointments Available

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