Policies & Forms
Policies & Forms
Learn about the policies that help us provide you with the very best of care.
Appointment & Office Policies
Appointments & Medical Advice
Our telephone triage nurse is available beginning at 8am Monday–Saturday to answer questions and to make appointments for sick visits. We understand children can become ill quickly and unexpectedly, which is why we reserve a portion of our daily schedule for sick children. Please call as early in the day as possible if you need to set up a same-day appointment. If you would like to speak with one of the physicians, please leave a message with the nurse or receptionist.Depending on the concern the doctor will call you back or have the nurse help you schedule a virtual visit.
When possible, call after 10am if you need medical advice or do not need to make an appointment for the current day. You also have the option to leave a recorded message about non-urgent matters that will be returned the same business day.
Missed Well Child Appointments
Please notify us if you cannot make a well child appointment at least 24 hours in advance. Without advanced notice, there will be a $50 fee for missed well child appointments.
Prescription Refills
Please request a medication refill at least three business days before you run out of your medicine. This allows the physician who wrote the prescription to verify that your current prescription is appropriate and refilled properly. Please call your pharmacy prior to picking up medications to make sure the prescription has been filled.
Transfer of Records
For transfer of records, a signed release and an administrative fee is required per record. Please allow 7 business days for completion. Please note for those patients over the age of 18, the individual patient is required to submit the written request for transfer of records.
School Forms
Health forms are required by many organizations including schools, daycare, camps, and school athletic departments. Health forms that are brought to a well child examination will be completed at that office visit. When forms are required at other times, they will be completed within seven business days. There is a $25 charge for each form.
Sports Physical Appointments
Virginia High School League (VHSL) guidelines require completion of a sports pre-participation physical between May 1st of the current calendar year through June 30th of the upcoming year. If your child has had a well-child exam prior to May 1st of this year, they will need to come into the office for a sports physical with updated medical history and physical examination prior to completion of the sports clearance form.
Unfortunately, most insurers do not cover the cost of this additional visit, required by VHSL as of March 2013. We charge a self-pay flat rate of $75. This includes the VHSL physical form, which is collected at the time of your appointment.
Laboratory
Pediatrics of Arlington is proud to have a high quality laboratory in our office. Our laboratory provides convenience for patients and families as well as timely results for more efficient care. In addition, your child will be in good hands with our lab technician who has over 30 years experience with pediatric patients.
In order to cover the laboratory operating costs and maintain our high quality of care, an administrative fee of $35.00 is charged for specimens collected. Please be aware that although your child’s specimen is collected at our office, labs other than newborn bilirubin or stat labs are sent to the lab that contracts with your insurance company (i.e. Quest or LabCorp).
We ask that a lab appointment be made for our patients with outside lab orders as well as those for whom one of our providers has ordered labs to be done at a later date.
Holiday Hours
- The office is open with regular hours on Columbus Day, Veterans Day, Martin Luther King Day, and Presidents Day.
- The office is open for a shortened day on Christmas Eve and New Year’s Eve.
- The office is closed on Thanksgiving, Christmas Day, New Year’s Day, Memorial Day, July 4th, and Labor Day.
Our physicians are available by phone when the office is closed.
Inclement Weather
We make every effort to be open when there is inclement weather. Please call the office or check our website for updates and information.
If our office ever has problems with the phone service, you can always reach one of the physicians by calling the answering service directly at (703) 558-0886.
Forms & Downloads
New Patient Forms
- Please complete these forms and bring them to your first visit.
- Family Medical History
- HIPAA Consent
- Telemedicine Consent
- Authorization for Release of Medical Records
- Financial and Administrative Policy
- Notice of Privacy Practices
Assessments
- Modified Checklist for Autism in Toddlers (M-CHAT)
- NICHQ Vanderbilt Assessment Scale (Parent)ADHD symptom rating scale, to be completed by a parent.
- NICHQ Vanderbilt Assessment Scale (Teacher)ADHD symptom rating scale, to be completed by a teacher.
School Forms
- Health forms are required by many organizations including schools, daycare, camps, and school athletic departments. Health forms that are brought to a well child examination will be completed at that office visit. When forms are required at other times, they will be completed within 7-10 business days. There is a $25 charge for each form.
- Commonwealth of Virginia School Entrance Health Form
- Virginia High School Athletic Participation Health Form
- District of Columbia School Entrance Health Form
- Arlington Authorization for Administration of Medicine at School
- Arlington Asthma Action Care Plan
- Arlington Severe Allergy Action Plan
- Arlington Tuberculosis Screening
- Arlington Acute Concussion Evaluation Care Plan
- Food Allergy & Anaphylaxis Emergency Care Plan
- Fairfax School Health ServicesImportant health authorization forms can be found here, including Epipen and inhaler authorizations.
After-Hours & Emergency Care
If you are dealing with a life-threatening emergency, please call 911 for an ambulance or go directly to the closest emergency room.
If your child has ingested a hazardous, poisonous, or unusual substance, call the poison control center immediately at (800) 222-1222.
Our after hours line is intended to be for urgent and emergency situations. For urgent medical issues when the office is closed, reach our on-call physician by calling our office at (703) 522-7300. Please leave a message with your child’s name and age, a contact phone number, a pharmacy number if needed, and a description of the medical issue. The on-call physician will call you back. There may be a fee assessed to after hours calls between 5-10PM.
Between 10pm and 8am, our answering service will connect you to a pediatric triage nursing service. Please note that this after-hours nursing service is not covered by most insurance plans and you will be charged a $25 fee to your child’s account.
COVID-19 Safety
We continue our ongoing efforts to limit COVID-19 transmission within our office, making adjustments to our procedures as the demands of the pandemic continue to change. We will keep you informed as these changes take place.
For all visits, as of April 1, 2022
- No siblings unless they are also being seen for an appointment.
- Masks are required for all parents/caretakers and children 2 years and older.
- Telemedicine appointments are offered for our established patients.
COVID-19 Resources
- COVID-19Centers for Disease Control and Prevention (CDC)
- 2019 Novel Coronavirus (COVID-19)HealthyChildren.org (AAP)
- COVID-19 Vaccine: Frequently Asked QuestionsAmerican Academy of Pediatrics
- COVID-19 HandoutsAAP Parent Education
- Virginia DSS Smartphone App for COVID-19 HelpVirginia Department of Social Services
- COVID-19 Anxiety WorkshopCOVID-19 Mental Health Resources
- Challenges Facing Kids During COVID-19PBS NewsHour
- Talking with Children About COVID-19Fred Rogers Center
We Are a Vaccinating Practice
At Pediatrics of Arlington we believe that all children and young adults should receive all recommended vaccines according to the schedule published by the American Academy of Pediatrics and Center for Disease Control. Regular vaccinations are administered as one of the safest and best methods of disease prevention.
Immunization Resources
- Immunization ScheduleCenters for Disease Control and Prevention (CDC)
- Vaccine Information StatementsCenters for Disease Control and Prevention (CDC)
- Vaccine Safety: The FactsAmerican Academy of Pediatrics
- COVID-19 Vaccine: Frequently Asked QuestionsAmerican Academy of Pediatrics
- VaccinateYourFamily.orgHelping to protect people of all ages from vaccine-preventable diseases
- National Network for Immunization Information
- Institute for Vaccine SafetyJohns Hopkins Bloomberg School of Public Health
