School / Daycare Forms

Most schools and daycares will require your child’s pediatrician to complete
health forms for enrollment purposes.

Please submit the form below so that we may help you in this process. Note that your child must have had a well-child checkup in our office within 365 days (1 Year) in order for us to complete the forms. If you need a sports physical form completed, the checkup must be after May 1st of the current year through June 30th of the succeeding year. If your child has not been seen according to these regulations, then please call our office to schedule a well-child or sports physical appointment.

School / Daycare Forms

Download and fill out the forms below before submitting them for processing.

Private School / Daycare Forms

Virginia Public Schools Physical Form

DC Public Schools Physical Form

Sports Physical Form

Immunization Records Only (No Charge)

Submit School / Daycare Forms

Use the form below to submit School / Daycare Forms for processing. Please be sure to fill out all the fields.

Name(Required)
How would you like the form returned to you?(Required)

Patient Information

Patient Name(Required)
MM slash DD slash YYYY

Submit Form

Select form your are submitting for processing
Accepted file types: pdf, Max. file size: 12 MB.

Payment

We will require payment before we start working on these forms unless your child has Medicaid. Insurance companies cannot be billed for this charge. We charge $10 for processing each form and our processing time is 5-7 business days. If you need it expedited, our charge is $20 and it will take up to 3 business days. Please use the link below to log in to your child’s patient portal to pay the appropriate charge. If you do not have the login credentials to the patient portal, then please call our office at 703-522-4780 to make payment after you have submitted this form electronically.

Make Payment via Patient Portal

A link for payment will also be provided after form submission

This field is for validation purposes and should be left unchanged.