Health forms not available on our website may be submitted by completing the cover sheet and attaching your child’s forms below. 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.

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.