Online
– 18 Year And Older Authorization To Disclose Protected Health Information
– Consent to Treat Minor Patient Without Legal Guardian Present
– NVPA Office Policies
– Flu/Covid Request
– FollowMyHealth Invite – Adult Patient Self-Request
– FollowMyHealth Invite – Parent/Guardian Request
– Patient Registration Form
– Referral Request Form
– Prescription Refill and Order
– Telehealth Consent Form
– Transfer FROM Northern Virginia Pediatric Associates, P.C. Form (Chart Request)
– Transfer TO Northern Virginia Pediatric Associates, P.C. Form
– 18 Year And Older Authorization To Disclose Protected Health Information
– Adolescent Questionnaire
– Consent to Treat Minor Patient Without Legal Guardian Present
– Flu/Covid Request
– Medication Follow-up
– NVPA Office Policies
– Patient Registration Form
– Prescription Refill and Order
– Referral Request Form
– Transfer FROM Northern Virginia Pediatric Associates, P.C. Form (Chart Request)
– Transfer TO Northern Virginia Pediatric Associates, P.C. Form
– Tuberculosis Screening Certificate
ADHD Assessment
ADHD Diagnostic Rating Scale
Completed Parent Forms can be uploaded through FollowMyHealth®, mailed, faxed, (703) 532-8426, or brought to the office. Completed Teacher forms can be faxed or mailed to the office.
Parent Rating
Teacher Rating
Parent Follow-up
Teacher Follow-up
School Forms
Virginia Forms
Allergy Action Plan
Falls Church City Public Schools Authorization for Virginia Asthma Action Plan
EPINEPHRINE AUTHORIZATION
MEDICATION AUTHORIZATION Release and Indemnification Agreement
School Entrance Health Form
VHSL Athletic Participation Form
Arlington County Public Schools
Medication Authorization including Epinephrine and Inhalers
Fairfax County Public Schools
Epinephrine Authorization
Inhaler Authorization
Medication Authorization
Falls Church City Public Schools
Medical Authorization including Epinephrine and Inhalers
DC Public Schools
Shot Record Request
A copy of child’s shot record / immunizations, can be viewed and printed from our secure FollowMyHealth® Messaging System.
If you do not currently have a FollowMyHealth® account, one can be set up quickly and easily. Click the button below to be directed to FollowMyHealth®. Previous patients no longer seen at the practice can also set up a FMH account.
Requests for immunization records outside of an office visit will incur an administrative charge of $10.00.
How do I view/print immunization records on FollowMyHealth?
On a Computer (recommended)
- Log in: Go to your FollowMyHealth portal on a web browser.
- Select Your Child’s Account: Before you do anything else, look at the very top of the page where it says “Hello, [Your Name]”, click this button and select your child from the dropdown menu.
- Navigate: Click the “My Health” tab or icon.
- Select Immunizations / : Choose the “Immunizations” tab from the sub-menu.
- Print/Export: Click the orange “Send” button and choose “Print” from the dropdown.
If Using the Mobile App
- Open App: Launch the FollowMyHealth app and log in.
- Select Your Child’s Account: Before you do anything else, look at the top left where it says “Accounts”, tap this button and select your child from the menu.
- Export: Use the app’s menu to find “My Health” and then the “Export” icon (top right). You will see the left icon for iPhones, right for Androids.
- Email: Select “Export Health Records”, select your desired sections, and click “Send” to email them to yourself.
- Print from Email: Open the email on your device or computer and print the records from there.
If you do not currently have a FollowMyHealth® account, one can be set up quickly and easily. Click the button below to be directed to FollowMyHealth®.