Please be advised if you submit multiple forms for one child or for multiple children you may receive them at separate times or even on separate days. We have not forgotten about any forms submitted. All of your forms are in the queue to be completed and will be returned within 5-7 business days. Please do not email inquiring about your “other forms” if you have already received one of them unless it is beyond 7 business days from the date of submission.
Follow these easy steps:
After you’ve submitted your forms (via verifying your digital signature) they will immediately drop into our queue for completion. When your forms are completed, you will immediately receive a finalized copy in your email.
Do you need just an immunization record? If so please request this through the patient portal!
In order for Potomac Pediatrics to complete health forms for your child, they are REQUIRED to have a physical within the past 12 months. You can verify if your child is up to date by logging into your patient portal and checking their appointment history or by contacting our office. Any request for health forms received for a patient that does not have an up to date well exam will be declined. Forms submitted prior to a scheduled well exam will be held until the appointment occurs at which time we will complete the requested forms. Please note that completion will not occur at the time of the appointment.
Bullis Health Forms
JDS Health Forms
JDS Asthma Action Plan (The ALA Asthma Action Plan form is the preferred form for JDS)
Maryland State Forms
(OCC1215) MD State Health Inventory Childcare Form (For most Daycares and PreSchools)
Montgomery County Health Forms
MCPS Authorization to Administer Prescribed Medications (for children with multiple medications)
Archdiocese Health Forms
Miscellaneous Health Forms
Is your school/camp form not available?
Email firstname.lastname@example.org a blank PDF copy and we will review the form you’ve submitted. If there is a high enough patient demand we will build an online version within 14 days for future automatic submission. We thank you for submitting blank copies to our office, and ask that you still submit your non-electronic forms using the cover sheet and form submission option below. Please note, we will not be building out private school forms that are replicas of Maryland State Forms.
Health forms not available on our website through automatic submission may be submitted by completing the cover sheet below and attaching your forms. Please ensure the parent section is completed prior to submitting your forms. Failure to complete the cover sheet and/or parent section will result in your forms being rejected.
Please note that all forms may take up to 7 business days to be completed. We receive the highest volume of health forms April-August, resulting in completion times that may take the full 7 days. Forms are completed as they are submitted. There is no fast-track or expedited process for late submissions.