Forms: School, Camp, or Daycare
Pediatric Associates of Alexandria has made our school, camp, and daycare forms an entirely electronic process for our patients via DocuSign. DocuSign is secure and HIPAA compliant. When the form is completed, it will be emailed directly back to you. This process allows for easier submission, easier completion, and reliable tracking of your forms. DocuSign will also allow you to choose from many different languages in the DocuSign settings.
Please be advised if you submit multiple forms for one child, or for multiple children, you may receive them at separate times or even on separate days. All of your forms are in the queue to be completed.
- Standard fee (7 business day turnaround): $15 per form*
- Expedited fee (1 business day turnaround ): $50 per form*
- Free when it is brought to well check appointments
* Business day does not include Saturday, Sunday, office closure due unforeseen circumstances (example: inclement weather), and holidays when the office is closed (New Years, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas).
Example: If an expedited form is submitted to our office on a Friday at 5:30 p.m., it will be completed by the end of PAA’s business day on Monday - as long as Monday is not a holiday or closed for other reasons previously listed.
The form fee will be collected online prior to submitting it to the office.
- Scroll through the list of forms below. You can also preview the form to see if it is the correct one your school, camp, or daycare is asking for. PAA has updated our list of forms, please review it entirely before selecting. PAA is not responsible if the wrong form is submitted.
- Don't see the form you need? Scroll to the bottom to find "Is your form not in our list" to upload a copy of the form you are requesting.
- Click on "Standard Form" or "Expedited Form" to initiate the process to send it to our office. Standard form is $15 and will be turned around in 7 business days. Expedited Form is $50 and turned around in 1 business day.
- Complete all of the required and optional portions of the form the parent/guardian is responsible for.
- When you are done filling out all of your parts of the form, and click "Finish" it will ask for your credit/debit card information. Your card will only be charged if the form is completed by the provider and it is emailed back to you.
- Please note: If your form is declined by a nurse or provider, you will be notified via the patient portal.
Please choose which type of form you'd like to complete.
- State of Virginia
- Fairfax County Public Schools
- Arlington County Public Schools
- Prince William County Public Schools
- Alexandria City Public Schools
- Loudoun County Public Schools
- Catholic School Forms
Commonwealth of Virginia School Health Form
Virginia Athletic Participation Form
Virginia Asthma Action Plan
Fairfax County Public Schools
Fairfax County Middle School Sports Form
Fairfax County Public School Authorization for Anaphylaxis Action Plan
Fairfax County Public School Medication Authorization
Arlington County Public Schools
Arlington County Medication Authorization
Arlington County Allergy Action Plan
Arlington County Tuberculosis Screening
Prince William County Public Schools
Prince William County Epinephrine Permission Form
Prince William County Medication Form
Prince William County Middle School Athletic Form
Alexandria City Public Schools
Alexandria City Public School Medication Authorization
Alexandria City Public School Epinephrine Authorization
Loudoun County Public Schools
Loudoun County Allergy Action Plan
Loudoun County Asthma Action Plan
Loudoun County Medication Authorization
Loudoun County Tuberculosis Screening
Catholic School Forms
Bishop O'Connell Immunization Certificate
Bishop O'Connell Sports Form
Office of Catholic Schools Food Allergy Action Plan
Office of Catholic Schools Inhaler or Nebulizer Authorization
Office of Catholic Schools Epinephrine Authorization
Office of Catholic Schools Medication Form
St. Stephens St. Agnes Immunization & Physical Form
Maryland School Form + Lead Test Certificate
Maryland Lead Test Certificate
Maryland State Department of Education Medication Authorization
Maryland Allergy Action Plan
Maryland Asthma Action Plan
Maryland Department of Health Immuniziation Certificate
Prince George County Public Schools
Prince George County Epinephrine Form
Prince George County Health Form
Prince George County Inhaler/Nebulizer Form
Prince George County Medication Form
Montgomery County Public Schools
Montgomery County Public Schools Anaphylaxis Management
Montgomery County Public Schools Physical Examination Form
Montgomery County Public Schools Medication Authorization
Montgomery County Public School Pre-Participation Athletic Form
Washington D.C. Forms
DC Universal Health Form
Washington DC Medication and Medical Procedure Authorization
DC Anaphylaxis Action Plan
District of Columbia Medication Authorization
Miscellaneous Forms (Various Camp, Daycare, Medication Forms)
Boy Scout Physical Form
Food Allergy and Anaphylaxis (FARE) Action Plan
Medication Authorization Form
Written Medication Consent Form
Tuberculosis Screening Form
Bright Horizons Allergy Health Care Plan
Bright Horizons Asthma Health Care Plan
Crystal City Children's Center Health Statement
Government Forms (Local, State, Federal)
WIC Infant Form - No Fee for This Form
WIC Child Form - No Fee for This Form
DMV Disabled Parking Placard or License Plate Application
Family Member Medical Summary (DD 2792)
Medical, Dental, Educational Suitability Screening (1300-1)
Overseas Screening Assignment (CG 1300B)
Report of Medical History (DD 2807-1)
Department of State Medical History and Exam (DS 1622)
Department of State Medical History and Exam (DS 1843)
University of Virginia Health Form
University of Mary Washington Immunization and Tuberculosis Screening
James Madison University Immunization Form
George Mason Immunization Form
Virginia Commonwealth University Certificate of Immunization
Virginia Tech Immunization Form
Is your form not in our list?
1. Please ensure your form is not in list of forms above.
2. Pre-op forms must be completed during an office appointment.