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