Patient Forms

Our forms process is now electronic and can be completed throughout patient portal.

We ask that new patients contact our office to schedule their first appointment. At that time, our staff will give you access to our patient portal. Through our patient portal, you will complete the remaining paperwork, which our staff will guide you through; additionally, you can view your child's entire medical records, send direct messages to triage nurses and schedule sick and well-check appointments.  Please arrive 20 minutes early for your initial appointments. 

Completing necessary paperwork online prior to your child’s visit helps quicken the check-in process. 

Forms Packets

• Newborn Information Packet (New Patient)
• New Patient Information Packet 

Individual Forms

• COVID Vaccine Consent Form, Pfizer EUA, Moderna EUA
• Telemedicine Consultation Form
• Prenatal Forms
• Authorization for Treatment (In absence of Parents/Guardians)
• Financial Policy

School, Camp & Daycare Forms

Pediatric Associates of Alexandria has made our school, camp, and daycare forms an entirely electronic process for our patients. We will no longer accept forms dropped off, emailed, mailed, or faxed to the office. We encourage you to bring any form(s) needed to your child’s well check appointment which will be done for free at that time.

Pediatric Associates of Alexandria ha hecho que nuestros formularios de escuela, campamento y guardería sean un proceso completamente electrónico para nuestros pacientes. Ya no aceptaremos formularios entregados, enviados por correo electrónico, por correo postal o por fax a la oficina. Lo alentamos a que traiga los formularios necesarios a la cita de control de bienestar de su hijo, que se realizará de forma gratuita en ese momento.

We will no longer accept forms that are emailed, dropped off, or faxed to the office.

Access Online Forms

Additional Forms

• Screening Forms - Vanderbilt ADHD Forms, Scared Patient AKG (Anxiety Related Disorders), M-Chat R/F (Autism), Behavioral Health forms for Therapy, PHQ9 (Depression)
• Forms for Developmental Pediatrician (Dr. Shropshire)
• Forms for Solution-Focused Therapy
• Medical Records Release
• Specialists Referrals
• Parent Survey
• Notice of Privacy Practices