Patient Forms

We are happy to complete forms for your child if your child is up to date with their age appropriate physical exam. Some organizations do require that your child have an exam within a year of starting the camp and state this on the form

Financial Policy for Forms:

  • School Form $20/Form (No charge if requested at a Well Check Visit)

  • School Form Rush Fee: $20 for each form + $25 for rush fee = $45 for 1 rush form: $65 for 2 rush forms; $85 for 3 forms, etc.

  • For more information see FORMS Financial Policy Explanation

To process your request, please follow the instructions below:

  •  If you need a Virginia School Form, call our Forms Line and leave a message (703-435-3636 OPTION 7).   

  •  For all other forms, fax or drop the form(s) off at our office or push them to the Portal. If you do not have an active Portal Account, call the Office for a PIN to register for the Portal.

  • **** Please be sure to include BOTH the name of the patient and your phone contact information,  in case we need to reach out and ask any questions AND complete the entire parent/student portion BEFORE sending it in. Any form requests sent in without information identifying who the patient is or do not have the completed information will not be processed ****. 

  • Most forms will be completed in 2-3 business days.  If you do not hear from us after 3 business days, please call the office 703-435-3636 OPTION 3 to speak with our nurses. If you need form(s) completed before 72 hours there is a RUSH FEE.