• PRINT Physical/Well-Child Form.
• Have your child’s primary care physician complete the Physical/Well-Child Form.
• Complete the submission form below to submit the Physical/Well Child Form in one of two ways:
  • Fax to (802) 867-0147
  • Take a photo or scan the form and select “attachment” below to upload and submit the Physical/Well Child Form.

PLEASE DO NOT SUBMIT A PAPER COPY.  USE ONLY THE METHODS ABOVE.