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301-279-6750

Phone

15204 Omega Drive

Suite #100 Rockville, MD 20850

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Form library

PLEASE…

  • Fill out our cover sheet for each child’s forms that need to be completed.
  • This sheet can be found by clicking here: Forms Cover Sheet or in our office at the front desk
    • The cover sheet and the parents section (often section I) MUST be completed for your child’s forms to be processed. Failure to complete these sections will delay the processing of your child’s forms.
  • Check to make sure your child’s name is written on each page
  • Provide a contact number on our cover sheet
  • Provide us with the forms that need to be completed for your child
    • Forms must be provided by the parent as we do not provide “general” school/camp forms.

**Please note the turn around time for processing your child’s health forms is 3 – 5 business days** How to get the forms to us

We are no longer accepting forms via fax due to the poor quality in which they are received. Please email, mail, or drop off forms for completion. Options to receive completed forms

  • Having them mailed to your home address
  • Picking them up in our office
  • Faxing directly to school, camp, or daycare at their secure fax number
    (Please do not select this option if you wish to review the forms prior to submission to school/camp/daycare)
  • Faxing directly to your home or work *Please provide the fax number on the corresponding section of the cover sheet along with initialing the authorization statement

*Please Note* Unfortunately due to HIPAA we cannot return forms via e-mail.

Montgomery County Health Forms

Charles E Smith Jewish Day School Health Forms

Frequently Submitted Camp Forms

Potomac Pediatrics will always be fully focused on helping your child and you to overcome any healthcare hurdle, with innovative, comprehensive and compassionate care.

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