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Phone
Suite #100 Rockville, MD 20850
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.
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
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
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 or GoDaddy. Emails occasionally end up in a junk/spam folder, be sure to check here. The encrypted link will expire after 48 hours so please open immediatley!
Please allow 5-7 business days to receive your form.
Click here for hour helpful, step-by-step “how to guide” or submit your question using the form below
General questions: Use the form below to submit any general questions about school/camp/daycare forms or our forms process.
Forms Status update: Please allow 5-7 business days for forms to be returned. If you have not received your form after this time, please use the form below to request an update. Remember that forms will come from ProofPoint or GoDaddy– please double check your inbox and junk folder before submitting your status inquiry.
Someone from our team will reply to your inquiry within 1 -2 business days.
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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