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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
Duke Street Office
2747 Duke Street, AAlexandria, VA 22314

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

Duke Street: Mon-Thu: 6am-8pm | Fri: 6am-6pm | Sat: closed | Sun: closed

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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 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.

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 has updated our list of forms, please review it entirely before selecting. 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 "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.
  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.
  6. Please note: If your form is declined by a nurse or provider, you will be notified via the patient portal.

Available Forms

Please choose which type of form you'd like to complete.

Virginia Forms

Maryland Forms

Remaining Forms

Virginia Forms

Commonwealth of Virginia School Health Form

Standard Form

Expedited Form

Preview Form

Virginia Athletic Participation Form

Standard Form

Expedited Form

Preview Form

Virginia Asthma Action Plan

Standard Form

Expedited Form

Preview Form

Fairfax County Public Schools

Fairfax County Middle School Sports Form

Standard Form

Expedited Form

Preview Form

Fairfax County Public School Authorization for Anaphylaxis Action Plan

Standard Form

Expedited Form

Preview Form

Fairfax County Public School Medication Authorization

Standard Form

Expedited Form

Preview Form

Arlington County Public Schools

Arlington County Medication Authorization

Standard Form

Expedited Form

Preview Form

Arlington County Allergy Action Plan

Standard Form

Expedited Form

Preview Form

Arlington County Tuberculosis Screening

Standard Form

Expedited Form

Preview Form

Prince William County Public Schools

Prince William County Epinephrine Permission Form

Standard Form

Expedited Form

Preview Form

Prince William County Medication Form

Standard Form

Expedited Form

Preview Form

Prince William County Middle School Athletic Form

Standard Form

Expedited Form

Preview Form

Alexandria City Public Schools

Alexandria City Public School Medication Authorization

Standard Form

Expedited Form

Preview Form

Alexandria City Public School Epinephrine Authorization

Standard Form

Expedited Form

Preview Form

Loudoun County Public Schools

Loudoun County Allergy Action Plan

Standard Form

Expedited Form

Preview Form

Loudoun County Asthma Action Plan

Standard Form

Expedited Form

Preview Form

Loudoun County Medication Authorization

Standard Form

Expedited Form

Preview Form

Loudoun County Tuberculosis Screening

Standard Form

Expedited Form

Preview Form

Catholic School Forms

Bishop O'Connell Immunization Certificate

Standard Form

Expedited Form

Preview Form

Bishop O'Connell Sports Form

Standard Form

Expedited Form

Preview Form

Office of Catholic Schools Food Allergy Action Plan & Treatment Authorization

Standard Form

Expedited Form

Preview Form

Office of Catholic Schools Medication Form

Standard Form

Expedited Form

Preview Form

St. Stephens St. Agnes Immunization & Physical Form

Standard Form

Expedited Form

Maryland Forms

Maryland School Form + Lead Test Certificate

Standard Form

Expedited Form

Preview Form

Maryland Lead Test Certificate

Standard Form

Expedited Form

Preview Form

Maryland State Department of Education Medication Authorization

Standard Form

Expedited Form

Preview Form

Maryland State Department of Education Allergy and Anaphylaxis Medication Administration Authorization Plan

Standard Form

Expedited Form

Preview Form

Maryland Asthma Action Plan

Standard Form

Expedited Form

Preview Form

Maryland Department of Health Immuniziation Certificate

Standard Form

Expedited Form

Preview Form

Prince George County Public Schools

Prince George County Epinephrine Form

Standard Form

Expedited Form

Preview Form

Prince George County Health Form

Standard Form

Expedited Form

Preview Form

Prince George County Inhaler/Nebulizer Form

Standard Form

Expedited Form

Preview Form

Prince George County Medication Form

Standard Form

Expedited Form

Preview Form

Prince George County Sports Form

Standard Form

Expedited Form

Preview Form

Montgomery County Public Schools

Montgomery County Public Schools Anaphylaxis Management

Standard Form

Expedited Form

Preview Form

Montgomery County Public Schools Physical Examination Form

Standard Form

Expedited Form

Preview Form

Montgomery County Public Schools Medication Authorization

Standard Form

Expedited Form

Preview Form

Montgomery County Public School Pre-Participation Athletic Form

Standard Form

Expedited Form

Preview Form

Washington D.C. Forms

DC Universal Health Form

Standard Form

Expedited Form

Preview Form

Washington DC Medication and Medical Procedure Authorization

Standard Form

Expedited Form

Preview Form

DC Anaphylaxis Action Plan

Standard Form

Expedited Form

Preview Form

District of Columbia Medication Authorization

Standard Form

Expedited Form

Preview Form

Miscellaneous Forms (Various Camp, Daycare, Medication Forms)

Preparticipation History and Physical Evaluation

Standard Form

Expedited Form

Preview Form

Boy Scout Physical Form

Standard Form

Expedited Form

Preview Form

Food Allergy and Anaphylaxis (FARE) Action Plan

Standard Form

Expedited Form

Preview Form

Medication Authorization Form

Standard Form

Expedited Form

Preview Form

Written Medication Consent Form

Standard Form

Expedited Form

Preview Form

Tuberculosis Screening Form

Standard Form

Expedited Form

Preview Form

Bright Horizons Allergy Health Care Plan

Standard Form

Expedited Form

Preview Form

Bright Horizons Asthma Health Care Plan

Standard Form

Expedited Form

Preview Form

Crystal City Children's Center Health Statement

Standard Form

Expedited Form

Government Forms (Local, State, Federal)

Child, Youth, and School Services Health Assessment/Sports Physical

Standard Form

Expedited Form

Preview Form

WIC Infant Form - No Fee for This Form

Standard Form

Preview Form

WIC Child Form - No Fee for This Form

Standard Form

Preview Form

DMV Disabled Parking Placard or License Plate Application

Standard Form

Expedited Form

Preview Form

Family Member Medical Summary (DD 2792)

Standard Form

Expedited Form

Preview Form

Medical, Dental, Educational Suitability Screening (1300-1)

Standard Form

Expedited Form

Preview Form

Overseas Screening Assignment (CG 1300B)

Standard Form

Expedited Form

Preview Form

Report of Medical History (DD 2807-1)

Standard Form

Expedited Form

Preview Form

Department of State Medical History and Exam (DS 1622)

Standard Form

Expedited Form

Preview Form

Department of State Medical History and Exam (DS 1843)

Standard Form

Expedited Form

Preview Form

College Forms

University of Virginia Health Form

Standard Form

Expedited Form

Preview Form

University of Mary Washington Immunization and Tuberculosis Screening

Standard Form

Expedited Form

Preview Form

James Madison University Immunization Form

Standard Form

Expedited Form

Preview Form

George Mason Immunization Form

Standard Form

Expedited Form

Preview Form

Virginia Commonwealth University Certificate of Immunization

Standard Form

Expedited Form

Preview Form

Virginia Tech Immunization Form

Standard Form

Expedited Form

Preview Form

Other Forms

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.

Standard Form

Expedited Form