Policies & Forms
Learn about the policies that help us provide you with the very best of care.
Registration forms for new patients, release and consent forms, and developmental assessment tools
School, camp, sports, daycare, and medication administration forms
Please bring any applicable forms that require a provider’s signature with you to your child’s yearly physical exam, so we can complete them at no additional cost to you. Please ensure that you complete all components of that form prior to your child’s arrival at our office.
If the necessary forms are not presented at the time of the yearly physical exam, but rather brought in or mailed to our office for completion after that visit, you will be charged a $20 administrative fee for each form.
If you need the form(s) in less than 72 hours, the charge is $20 for each form PLUS an extra $25 rush fee for the form(s).
For example, if a family is requesting 3 forms for 3 children with a rush request, the total charge is $60+$25 = $80 Total for forms. Fees will be due prior to pickup of the completed forms.
If you are requesting that our office mail your child’s form back, you will need to send payment along with that form. Please be aware that these fees are not covered by your medical insurance policy.
RTC Pediatrics is closely monitoring the current CDC guidelines to keep everyone safe.
Inform us if your child or anyone at home is not feeling well or was exposed to someone with Covid-19.
For all in-office visits:
We’ve assembled a collection of helpful and reliable Covid-19 resources for our families.
We are not scheduling Covid Vaccine Clinics at this time.
The new COVID-19 vaccine is now available at My Dr's Pharmacy in Herndon for individuals 6 months and older.
Please visit their website for more information regarding Insurance and scheduling.
At RTC Pediatrics, we believe that all children should receive the recommended vaccines according to the schedule provided by the American Academy of Pediatrics (AAP) and the CDC. Vaccines are safe and effective in preventing diseases and their subsequent health complications.
For the safety of all our patients, families and staff, we require all of our patients to receive all recommended vaccines by age 2. We are happy to discuss any concerns about vaccines at your child’s next visit.
Monday - Friday
8:00 am - 6:00 pm
Telephone advice available 8am - 1pm, 2pm - 5pm
9:00 am - 12:00 pm
By appointment only
We are closed for Christmas Day, New Years Day, Memorial Day, Independence Day, Labor Day, and Thanksgiving Day.
8:00 am - 9:00 am
BY APPOINTMENT ONLY -
8:00 am - 9:00 am
Our Walk-In Sick Clinic on Monday and Friday is for children with minor illness symptoms lasting less than a week. Patients are seen on a first come-first served basis. Please bring your insurance card and be prepared to pay your copay, if applicable.
If your child’s illness or injury is life threatening, call 911.
Save time and call us before you take a trip to urgent care. When the office is closed, you may choose to be connected to our after-hours answering service. If needed, they can connect you to the physician on call. The fee to speak to someone after hours is $25/call. This service is not billed to your insurance.
Poison Control Hotline