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 firstname.lastname@example.org
. 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 email@example.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. Most forms require a physical within the last year. Please review the form to determine the specific requirements for that organization.
If you have questions about forms, please contact Faith Jackson. She can be reached directly at (301) 631-8013 or by email at firstname.lastname@example.org
ADD / ADHD (Vanderbilt) Forms