{"id":45,"date":"2014-06-04T18:56:09","date_gmt":"2014-06-04T18:56:09","guid":{"rendered":"http:\/\/ashburnpediatrics.com\/w\/?page_id=45"},"modified":"2025-05-08T13:35:56","modified_gmt":"2025-05-08T13:35:56","slug":"forms","status":"publish","type":"page","link":"https:\/\/ashburnpediatrics.com\/?page_id=45","title":{"rendered":"Forms"},"content":{"rendered":"<p><strong>Email the office with forms or general information, please be aware this email is only checked during normal business hours Monday thru Friday. This email is NOT intended to be used for any questions regarding patient\u2019s health or medical concerns. School forms may be sent to this email, however, they will be returned to you if the front portions\/pages to be completed by parent are not completed. There is a $25 charge for all forms. For your convenience the VA school entrance form which requires a TB screening to be completed is available here, as well as the VHSL sports form and the basic LCPS medication form.<\/strong><br \/>\nAshpedsfrontdesk@lmgdoctors.com<\/p>\n<p>&nbsp;<\/p>\n<h2>All of our forms can be found here:<\/h2>\n<p>&nbsp;<\/p>\n<ul><!--\n \t\n\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"https:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2020\/08\/ashfluconsent.pdf\" target=\"_blank\" rel=\"noopener norefferer noreferrer\">2020-2021 Flu Vaccine Consent form<\/a><\/li>\n\n\n--><\/p>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"https:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2023\/06\/demo_1-23-2020-6.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">New Patient Registration Form<\/a><\/li>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"http:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2019\/08\/recordsRelease-8_16_19.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Medical Release Form<\/a><\/li>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"http:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2014\/06\/financial-policy.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Financial policy form<\/a><\/li>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"http:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2014\/06\/HIPAA-release.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Notice of Patient Privacy Practices form<\/a><\/li>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"http:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2016\/02\/Initial-History-Questionnaire-2-25-16.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Initial Patient History Questionnaire<\/a><\/li>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"https:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2020\/12\/Sports-Participation-Questionnaire-1.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Sports Participation Form<\/a><\/li>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"https:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2023\/02\/Authorization-for-Medication-Administration-LOUDOUN-COUNTY-PUBLIC-SCHOOLS.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Authorization for Medication Administration<\/a><\/li>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"https:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2025\/05\/VHSL-Physical-Evalution-Form-04-2025-2.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">VHSL has updated their sports forms to a 14 month duration. This new form is required to be used after July 1, 2025. This new rule will allow althetes to receive their sports visit at their medical home as recommended by the AAP<\/a><\/li>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"https:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2024\/12\/UPDATED-SCHOOL-FORM-JUNE-2024.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">School Health Entrance Form<\/a><\/li>\n<li><a style=\"font-weight: bold; color: #003366;\" href=\"https:\/\/ashburnpediatrics.com\/wp-content\/uploads\/2023\/02\/TB-RISK-QUESTIONS.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Tuberculosis (TB) Screening<\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>All of our forms are available here.<\/p>\n","protected":false},"author":1,"featured_media":119,"parent":12,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=\/wp\/v2\/pages\/45"}],"collection":[{"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=45"}],"version-history":[{"count":56,"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=\/wp\/v2\/pages\/45\/revisions"}],"predecessor-version":[{"id":1923,"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=\/wp\/v2\/pages\/45\/revisions\/1923"}],"up":[{"embeddable":true,"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=\/wp\/v2\/pages\/12"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=\/wp\/v2\/media\/119"}],"wp:attachment":[{"href":"https:\/\/ashburnpediatrics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=45"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}