School Forms

School Forms

Check here for the most common forms needed in the DMV! Capital Area Pediatrics charges $15 per separate form.  

Please complete all parent portions (especially name and date of birth, name of medications needed) before submitting to us.

Please read our  Tips for School/ Camp Form Completion.

• Virginia School Entrance Form(opens in a new tab). Page 1 should be completed by you. Please complete this TB questionnaire for the provider to complete your form.  
• VHSL Sports Form (High School Sports). (opens in a new tab)*NEW FORM as of APRIL 2025* Please print pages 1-6 and complete pages 1, 2, 4 and 5 before submitting your form.  Page 3 must be signed and stamped by us to keep on file at your school.  
• Arlington County forms:
  • Medication Administration Form(opens in a new tab)
  • Arlington County TB Risk Screen Form
  • TB screening questionnaire
  • Asthma Action Plan
  • Allergy Action Plan
• Fairfax County forms:
  • Medication Authorization Form
  • Anaphylaxis Action Plan
  • FCPS Asthma Action Plan (needs parent signature only)
  • Virginia Asthma Action Plan (needs provider signature)
• Falls Church City School Forms
• Loudoun County forms:
  • Loudoun County TB clearance form
  • TB screening questionnaire
  • Medication Administration Form(opens in a new tab)
  • Allergy Action Plan
  • Asthma Action Plan
• Prince William County School Forms
• Maryland forms:
  • Maryland State Record of Physical Examination
  • Lead Testing Certificate
  • Immunization Certificate
• Washington DC forms:
  • DC Universal Health Form for school entrance(opens in a new tab). Part 1 should be completed by you.
  • DC Medication Authorization Form(opens in a new tab)
  • DC Asthma Action Plan
  • DC Anaphylaxis Plan
• Boy Scouts Form(opens in a new tab).  Please fill out Parts A and B and bring to your appointment.  The provider must complete Part C.