Patient Forms & Requests:

EMAILING SCHOOL FORMS?
IMPORTANT!
PLEASE make sure that you have completed the following BEFORE EMAILING the entire form in a PDF or Word Format

Name and DOB on ALL pages.           
​DC school form
VA school form                      
VHSL sports form
Boy Scouts

COMPLETE PARENT SECTION:
​Top box
​All of page one
All of pages 1 and 2
​All of part B both pages

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 Statement of Responsibility
• Patient Information and Consent Form For All CMA Telemedicine Sessions​ (pdf)
• Patient Information and Consent Form For All CMA Telemedicine Sessions​ (word)
• Patient Registration Forms
• ​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
• ​Mental Health appointment forms

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