School/Camp Form Submission - Potomac Pediatrics

Health Form Submission

Forms Request

Please follow the steps below to request your School/Camp/Daycare form. A copy of your child’s immunization record will be included with this form. If you ONLY need an immunization record, follow the instructions at the bottom of this page.

Your child must have a Well Child Exam (WCE) within the past 12-months in order for a form to be completed. Forms submitted without a WCE in the past 12-months will be declined or held until a WCE appointment is completed.
Please allow 5-7 business days for forms to be returned to you. Please note we do NOT accept expedited request as doing so would only delay our ability to return forms back to the parents who submitted first. Please rest assured, we will always deliver your forms within the specified timeframe. If you need forms same day, please schedule an appointment in our office or at POP NOW to have your clearance forms completed. Please note, appointments for sports physicals are subject to a $50 self pay fee due at the time of service.
If multiple forms are submitted, they may be returned at different times or different days.
Forms must be submitted through this process, we do not accept paper forms in the office.

Step 1: Find and Complete the appropriate form from the list below

If your form is not included in this list, please click the button at the bottom of this section

Once you complete the form and verify your digital signature the form will be dropped into our queue

Bullis Health Forms

Camp Forms

JDS Health Forms

Maryland State Forms

Montgomery County Health Forms

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.

This form includes the COVID-19 supplemental questions sheet.

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

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.

Archdiocese Health Forms

Miscellaneous Health Forms

Step 2: Check your email

Once a form is complete, it will be dropped into the queue. Forms will be completed in the order they were received

Completed forms will be sent to you via encrypted email from ProofPoint. Emails occasionally end up in a junk/spam folder, be sure to check here.

Please allow 5-7 business days to receive your form.

Need Help?

Click here for hour helpful, step-by-step “how to guide”

Immunization Records ONLY

If you ONLY need Immunization records, click the button below

Immunization records are included with each School/Camp form, you DO NOT need to submit a separate request.

Please note records are not individually signed, the Potomac Pediatrics stamp on the form serves as the signature

Questions?

301-279-6750

15204 Omega Drive