School Forms

One health/camp/sports form can be completed upon request at the patient’s annual well visit at no charge. Form(s) completed outside of a well-visit and, each additional form completed, will be charged an administrative fee of $15.00.  The patient’s section should be completed before forms are dropped off. Please allow 7 to 10 business days for completion. Upon your request, and if available, forms may be expedited for an additional fee.

Virginia Forms

Allergy Action Plan
Asthma Action Plan
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