Registration Forms

• Registration Form
• Registration Form (Spanish)
• Financial Authorization
• Financial Authorization  (Spanish)
• Insurance Assignment Authorization
• Medical Authorization for Alternate Caregiver
• Full Registration Packet (Newborns and new patients only)

School Forms

Check here for commonly needed forms for Virginia and Washington DC. Capital Area Pediatrics charges $10.00 per school form.

• Virginia School Form. Please print and complete page 1 of this form. Pages 2 and 3 will be printed from your child's medical records.
• VHSL Sports Form (High School Sports). Please print and bring all 4 pages to your appointment. Page 2 must be completed prior to the visit. The provider must review page 2 before he/she can complete the form
• Washington DC Health Form for school entrance. Please print and bring both pages with you to your appointment. Section 1 should be filled out by you.
• Washington DC Medication at school. Please fill out all applicable forms
• Fairfax County Health and Medication forms. Please fill out all applicable forms
• Loudoun County Medication forms. Please fill out all applicable forms
• Arlington County Health and Medication forms. Scroll down to Health Requirements for Entry into School and find all applicable forms
• Boy Scouts Forms ABC.  Please fill out all applicable forms and bring to your appointment.  The provider must complete form C.