Patient Forms & Requests:

Forms may be faxed or emailed to our offices at:
Alexandria Office Fax: 703-914-5494; E-mail: forms.alex@cmanva.com
Fairfax Office Fax: 703-691-4791; E-mail: forms.ffx@cmanva.com
There is a $10 fee per completed form.
​Please allow 2-3 days for form completion.

CMA Patient Forms:

• Patient Registration Forms (2 pages)
• ​CMA Medical Records Release Form
• CMA Notice of Privacy Practices
• Patient Acknowledgement and Consent Form
• Patient eMail Consent Form
• ​Authorization for Treatment of Minors​
• Eighteen Year Old's Responsibility

Commonwealth of Virginia School Forms:

• ​Physical Exam Form
• VHSL Athletic Participation Form​​

Fairfax County School Forms:

• Medication Authorization Form
• Epinephrine Authorization Form
• Inhaler Authorization Form
• OTHER FAIRFAX COUNTY SCHOOL FORMS

City of Alexandria School Forms:

• Medical Authorization Form (Pre-K through 8th Grade)
• Medical Authorization Form (9th through 12th Grade)
• Epinephrine Authorization Form
• Inhaler Authorization Form
• OTHER CITY OF ALEXANDRIA SCHOOL FORMS

Arlington Public Schools Forms:

• Commonwealth of Virginia School Entrance Health Form
  
• Tuberculosis Screening Form
• OTHER ARLINGTON PUBLIC SCHOOLS FORMS
  

District of Columbia School Forms:

• District of Columbia Universal Health Certificate
  
• OTHER DISTRICT OF COLUMBIA SCHOOL FORMS