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Going to Camp this Summer? Traveling? Need a Health Form?

Camp, school and medication forms are to be filled out as much as possible prior to submitting either via Keona (preferred) or dropping off* at the office for completion.  (If applicable, please be sure to complete medication section).  Please also ensure that your child has had a physical exam within 12 months of form request.   Some common forms can be downloaded on Keona or found on this website under the forms tab.  Once a form is received, it may take between 5 and 7 business days for completion.  Forms completed through Keona will be emailed back. You will receive a call for forms dropped off* when completed unless prior arrangements have been made.  There is an administrative charge of $15 per form.  Expedited forms are completed within 48 hours with an administrative charge of $25 and same day for a fee of $50.

*Forms can be dropped off, mailed or faxed to 703-532-8426.  Due to HIPPA regulations, completed forms may be faxed back upon prior authorization and confirmation that a parent is present to receive the fax.

Please check all forms to confirm the date last physical is required. Patient’s last physical may satisfy requirements and a new physical may not be necessary. Verify and understand your coverage as some insurance companies may not cover a second physical within the same year.

**Some forms also require that a self Tuberculosis Risk Assessment be checked off.  Checking off this box prior to dropping off the form will greatly speed up processing time. 
Click below for a Tuberculosis Screening Certificate to assist with this process.