Camp, School and Sports Forms
Camp, School and Sports forms are to be filled out as much as possible prior to submitting to the office for completion. (If applicable, please be sure to complete medication section). Please also ensure that your child has had a physical exam within 12 months of form request. Some common forms can be found on this website under the forms tab. Once a form is received, it may take between 7 and 10 business days for completion. Once complete, a call will be placed for pick up unless prior arrangements have been made. There is an administrative charge of $15 per form. Expedited forms are completed within 48 hours with an administrative charge of $25 and same day for a fee of $50.Forms can be dropped off, faxed to 703-532-8426. or emailed to This email address is being protected from spambots. You need JavaScript enabled to view it.; Due to HIPPA regulations, completed forms may be faxed back upon prior authorization and confirmation that a parent is present to receive the fax.
Please check all forms to confirm the date last physical is required. Patient’s last physical may satisfy requirements and a new physical may not be necessary. Verify and understand your coverage as some insurance companies may not cover a second physical within the same year.
**Some forms also require that a self Tuberculosis Risk Assessment be checked off. Checking off this box prior to dropping off the form will greatly speed up processing time.
Click below for a Tuberculosis Screening Certificate to assist with this process.
https://www.northernvirginiapediatrics.com/PDF/fillable/Form_Tuberculosis-Screening-Certificate.pdf
