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 (Word format).

• 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):

ID request for online Patient Access
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