logo for print
Phone & Fax Numbers for All Locations
Phone: 703-924-2100 | Fax: 703-922-6067

Inova Healthplex Office
6355 Walker Lane, Ste 401, Alexandria, VA 22310
Potomac Yard Office
3600 S. Glebe Rd., Ste 150, Arlington, VA 22202

OPEN 7 DAYS A WEEK!

Inova Healthplex: Mon-Thu: 6am-8pm | Fri: 6am-6pm | Sat: 8am-12pm | Sun: closed

Potomac Yard: Mon-Thu: 6am-8pm | Fri: 6am-6pm | Sat: closed | Sun: 8am-12pm

MENU

Forms: School, Camp, or Daycare

Direcciones en Español

Pediatric Associates of Alexandria has made our school, camp, and daycare forms an entirely electronic process for our patients, and these online forms are available now. 

We use DocuSign. It is a secure, HIPAA compliant and will be emailed directly back to you after it is completed. This process through DocuSign 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*

* 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 5:30 p.m. 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.

Directions

  1. 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 is not responsible if the wrong form is submitted.
  2. 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.
  3. Click on "Online Live Form" to initiate the process to send it to our office.
  4. Complete all of the required and optional portions of the form the parent/guardian is responsible for.
  5. 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 choose which type of school, camp, or daycare form you'd like to complete.


Formas: escuela, campamento o guardería

Pediatric Associates of Alexandria ha hecho que nuestros formularios de escuelas, campamentos y guarderías sean un proceso completamente electrónico para nuestros pacientes, y estos formularios en línea están disponibles ahora. A partir del 01/08/2022, ya no aceptaremos formularios que se envíen por correo electrónico, se dejen o se envíen por fax a la oficina.

Usaremos DocuSign. Es seguro, cumple con HIPAA y se le enviará directamente por correo electrónico una vez que se haya completado. Este proceso a través de DocuSign permite un envío más fácil, una finalización más fácil y un seguimiento confiable de sus formularios. DocuSign también le permitirá elegir entre muchos idiomas diferentes en la configuración de DocuSign.

Tenga en cuenta que si envía varios formularios para un niño o para varios niños, es posible que los reciba en momentos distintos o incluso en días distintos. Todos sus formularios están en la cola para ser completados.

  • Tarifa estándar (entrega de 7 días hábiles): $15 por formulario*
  • Tarifa acelerada (1 día hábil de entrega): $50 por formulario*

* El día hábil no incluye sábado, domingo, cierre de la oficina debido a circunstancias imprevistas (ejemplo: mal tiempo) y días festivos cuando la oficina está cerrada (Año Nuevo, Día de los Caídos, Día de la Independencia, Día del Trabajo, Acción de Gracias y Navidad).

** Ejemplo: si se envía un formulario acelerado a nuestra oficina un viernes a las 5:30 p.m., se completará antes de las 5:30 p.m. del lunes, siempre que el lunes no sea feriado o esté cerrado por otros motivos mencionados anteriormente.

La tarifa del formulario se cobrará en línea antes de enviarlo a la oficina.

Direcciones

  1. Desplácese por la lista de formularios a continuación. También puede obtener una vista previa del formulario para ver si es el correcto que solicita su escuela, campamento o guardería. PAA no es responsable si envía el formulario incorrecto para que lo completemos.
  2. ¿No ve el formulario que necesita? Desplácese hasta la parte inferior para encontrar "¿Su formulario no está en nuestra lista?" para cargar una copia del formulario que está solicitando.
  3. Haga clic en "Online Live Form" debajo del nombre del formulario que necesita para iniciar el proceso.
  4. Complete todas las partes obligatorias y opcionales del formulario del que es responsable el padre/tutor.
  5. Cuando haya terminado de completar todas las partes del formulario y haga clic en "Finalizar", se le pedirá la información de su tarjeta de crédito/débito. Su tarjeta solo se cargaré si el proveedor completa el formulario y se lo envía por correo electrónico.

Elija qué tipo de escuela, campamento o formulario de guardería le gustaría completar.


Virginia Forms


Commonwealth of Virginia School Health Form

Online Live Form

Preview Form


Virginia Athletic Participation Form

Online Live Form

Preview Form


Fairfax County Public School Epinephrine Authorization

Online Live Form

Preview Form


Fairfax County Public School Medication Authorization

Online Live Form

Preview Form


Virginia Asthma Action Plan

Online Live Form

Preview Form


Arlington County Medication Authorization

Online Live Form

Preview Form


Arlington County Allergy Action Plan

Online Live Form

Preview Form


Arlington County Tuberculosis Screening

Online Live Form

Preview Form


Prince William County Epinephrine Permission Form

Online Live Form

Preview Form


Prince William County Medication Form

Online Live Form

Preview Form


Alexandria City Public School Medication Authorization

Online Live Form

Preview Form


Prince William County Middle School Athletic Form

Online Live Form

Preview Form


Maryland Forms


Maryland School Form + Lead Test Certificate

Online Live Form

Preview Form


Maryland Lead Test Certificate

Online Live Form

Preview Form


Prince George County Epinephrine Form

Online Live Form

Preview Form


Prince George County Health Form

Online Live Form

Preview Form


Prince George County Inhaler/Nebulizer Form

Online Live Form

Preview Form


Prince George County Medication Form

Online Live Form

Preview Form


Maryland State Department of Education Medication Authorization

Online Live Form

Preview Form


Washington D.C. Forms


DC Universal Health Form

Online Live Form

Preview Form


Washington DC Medication and Medical Procedure Authorization

Online Live Form

Preview Form


Miscellaneous Forms


Boy Scout Physical Form

Online Live Form

Preview Form


Food Allergy and Anaphylaxis (FARE) Action Plan

Online Live Form

Preview Form


Medication Authorization Form

Online Live Form

Preview Form


CYS Services

Online Live Form

Preview Form


WIC (Infant Form)

Online Live Form

Preview Form


Tuberculosis Screening Form

Online Live Form

Preview Form


Written Medication Consent Form

Online Live Form

Preview Form


College Forms


University of Virginia Health Form

Online Live Form

Preview Form


University of Mary Washington Immunization and Tuberculosis Screening

Online Live Form

Preview Form


James Madison University Immunization Form

Online Live Form

Preview Form


George Mason Immunization Form

Online Live Form

Preview Form


Virginia Commonwealth University Certificate of Immunization

Online Live Form

Preview Form


Virginia Tech Immunization Form

Online Live Form

Preview Form


Other Forms


Is your form not in our list?

Online Live Form