The following forms to be filled out by a provider require the child to have had a well child check up in the last twelve months:
- School/Daycare Physical Forms
- Sports Physical Forms
- Administration of Medication Forms
- WIC Forms
- FMLA Forms
Medical Records
When requesting a child’s medical records the following may apply. Click here for a Request for Medical Records form (PDF).
- The first copy of medical records is a free courtesy copy. Any excess copies will cost $10.00 with a fifty cents per page charge (up to fifty pages).
- Medical records that exceed fifty pages will have a twenty-five cents charge per page
- A signed medical release form is required for all medical records except for shot records
- Medical records may take up to two weeks to process
- For any further questions regarding medical records, please contact the business department at 757-967-9750
New Patient Information Packet (all are in Word format):
Patient History Form
Patient Information Form
Medical Care Authorization Form
Financial Policy Form
Initial developmental testing packet
Attention Deficit Parent and Teacher Forms (pdf format)
Parent Informant
Teacher Informant
Follow-up Parent Informant
Follow-up Teacher Informant
Employment Application
Employment Application PDF