Forms and Policies
For your convenience, we have provided links to many useful office and school forms in PDF format. If you need a free copy of Adobe Reader, please visit www.adobe.com.
Office Forms
- Authorization for Release of Medical Records
- M-CHAT- Modified Checklist for Autism in Toddlers
- ADHD Symptom Rating Scales
School Forms
- Commonwealth of Virginia School Entrance Health Form
- Virginia High School Athletic Participation Health Form
- District of Columbia School Entrance Health Form
- Authorization for Administration of Medicine at School - Arlington
- Asthma Action Care Plan - Arlington
- Severe Allergy Action Plan - Arlington
- Authorization for Administration of Medicine at School - Fairfax
- Authorization for Inhaler Use at School - Fairfax
Policies
School Forms
Health forms are required by many organizations including schools, daycare, camps, and school athletic departments. Health forms that are brought to a well child examination will be completed at that office visit. When forms are required at other times, they will be completed within 7-10 business days. There is a $10 charge for each form.
Prescription Refills
Please call your pharmacy and have them FAX a refill request to our office at 703-522-0495. This allows your physician to verify that your current prescription is appropriate and refilled properly.
ADHD medication prescriptions must be handwritten by a physician. Please call or FAX our office to request ADHD medication refills.
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