Health forms are a necessary process when it comes to enrolling your child in school, sports, camp, or other physical activities. We are striving to make your lives easier when it comes to these forms. With our updated process you can expect the following:

  • Easier completion & submission
  • Faster turnaround time
  • HIPAA compliant & secure
  • Increased reliability from start to finish

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 HERE

Immunization records are attached to all health forms and have a Potomac Pediatrics stamp. Due to the nature of this process, we do not “sign” the form but the stamp constitutes an official record.

If you only need an immunization record, please request it HERE.

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.

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.

COVID-19 Supplemental Questions Sheet

Bullis Health Forms

Bullis 2022-2023 Health Form

Bullis School Asthma Action Plan & Authorization

Bullis School Allergy Action Plan

Camp Forms

Capital Camps

Boy Scouts Camp

Camps Airy and Louise Medical Forms

JDS Health Forms

2020-2021 JDS Health Assessment Forms

2022-2023 JDS Sports Physical Form

2022-2023 JDS Authorization to Administer Prescribed Medication Form

2022-2023 JDS Non Prescription Medication Form

2022-2023 JDS Anaphylaxis/Severe Allergy Form

2022-2023 JDS Asthma Action Plan Form

Maryland State Forms

Maryland State Health Inventory Form

(OCC1215) MD State Health Inventory Childcare Form (For most Daycares and Preschools) 

Maryland State Childcare Medication Authorization Form

Maryland State Asthma Medication Authorization Form

Maryland State Asthma Action Plan Form

Maryland State Lead Form

Maryland State Child Care Asthma Medication Administration Authorization Form

Maryland State Allergy Action Plan Form

Maryland State Emergency Form

Maryland State Medication Administration Authorization Form

Montgomery County Health Forms

MCPS R-6 Student Record Card 6

  • If your child is entering an MCPS school for the first time or is entering Kindergarten, you will need to complete the MCPS Student Record Card.

MCPS Pre-Participation Form for Athletes (SR-8)

  • This form includes the COVID-19 supplemental questions sheet.

MCPS Authorization to Administer Prescribed Medications

  • On the cover sheet please specifically list the medication you are requesting this for this form.

MCPS Authorization to Administer Prescribed Medications (for children with multiple medications)

  • If your child will need prescription medication or over-the-counter medication at school, you must complete one form for each medication. Please note this is a mandatory requirement per MCPS.

2022-2023 MCPS Epipen Authorization            Epipen Shortage Notice-

Montgomery County Asthma Action Plan & Medication Authorization Form


Archdiocese Health Forms

Archdiocese Health Inventory Form

Archdiocese Inhaler Authorization Form

Archdiocese Allergy Action Plan

Archdiocese Medication Authorization Form

Miscellaneous Health Forms

Age of Consent Form/ Authorization to Release Medical Information

DC Universal Health Certificate Form

Good Counsel Physical Exam Health Form

BBYO Teen Medication Form

McLean Sports Physical Form


Is your school/camp form not available?

Email 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.

Follow these easy steps HERE

Immunization records are attached to all health forms and have a Potomac Pediatrics stamp. Due to the nature of this process, we do not “sign” the form but the stamp constitutes an official record.

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.

    Patient Name:DOB:

    Today's Date:

    Phone number: Email:

    • Is your child currently taking any medications?    

      1. If yes, please list all medications and dosages. Including any over the counter, herbal, vitamins, or sport supplements:

    • Will these medications be taken at school/ camp/ daycare? 

      1. If yes, are there specific times the medication needs to be given? Dosages?

    • Does your child have any allergies to food or medications? 

      1. If yes, please list below.

    • Is there anything else that you would like the school/ camp or daycare to know about your child? 

      1. If yes, please list below.

    • Did you opt out of the annual NCSF? 

      1. Number of forms being submitted:

    : I acknowledge that if I am on the a la carte model my credit card on file will be charged for each separate form that is completed, and if I have opted into the NCSF, forms are included in my annual fee and no additional payment is due at this time.

    Attach Form :