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
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