Forms

Medical Records Release - TO The Pediatric Group (PDF)

Please send this completed form to your previous medical provider or specialist to have your child's medical records sent to our practice. They can FAX your records to TPG Pediatrics at (855) 308-2338

Medical Records Release - FROM The Pediatric Group (PDF)

Please send this completed form and the records transfer ©y fee to the TPG office where your child is seen. Please allow approximately two weeks for the requested medical records to be copied.

Virginia School Entrance Form (PDF)

Many public and private schools in Virginia require this form to be filled out by your child's doctor prior to enrolling your child in school. **Please fill out the first page of this form prior to having our office complete this form.

VHSL - April 2025 Sports Physical Form (PDF)

Virginia High School League's Athletic Participation/ Parental Consent/ Physical Examination form is required for high school students to try-out for or participate in VHSL sanctioned sports. In order for our medical providers to complete the physical examination section of the form, the first and second page must be filled out.

Parent-Vanderbilt Assessment Scale (PDF)

Please fill this form out and print the completed form off. You can FAX your completed form to TPG Pediatrics at (855) 308-2338

Teacher-Vanderbilt Assessment Scale (PDF)

Please print this form off and ask your child's teacher(s) fill it out. Once they are done, they can FAX the form to TPG Pediatrics at (855) 308-2338. We will need this form prior to your Parent-only consult appointment.

Annual Medical-and-Family-History for Patients UNDER 18 years old -English-and-Spanish

Please complete this form and bring it to your yearly check-up.

18 Years and Older Annual Check Up Form

Please complete this form and bring it to your yearly check-up.

Medical Records Release - FROM The Pediatric Group (PDF)

Medical-and-Family-History-English-and-Spanish

Please complete this form and bring it to your child's first appointment.