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Dr. Susan Chaitovitz is on call this evening
 

Forms & Policies

School / Daycare Forms

NEED A COPY OF A VACCINE RECORD?
If you would like a copy of your child's vaccine records only feel free to email us your request records@thepedcenter.com.  Please include the patient's name and date of birth.  With your permission we will glady email the vaccine record back to you.

NEED A PRESCRIPTION REFILL?
You may use our Prescription Refill Request Form. This form can be printed and faxed to our office at 301-695-8604. You can also download the form and email to refills@thepedcenter.com. Please allow three business days (M-F) to complete requests. We will contact you if the request will take longer than three business days. Please send in one form for each child.

FORM REQUESTS - HELPFUL TIPS
Parents, please make sure that you print ALL pages of the school/daycare/camp forms.  The parent portion of the forms should be filled out in its entirety, along with a parent signature, prior to bringing it to your appointment or dropping it off at one of our offices.  Please keep in mind that it takes about 3-5 business days to have school/daycare/camp forms completed.  

If you have questions about forms, please contact Faith Jackson.  She can be reached directly  at (301) 631-8013 or by email at forms@thepedcenter.com.
 

ADD / ADHD (Vanderbilt) Forms


Medical Records


Other


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