Office Forms
We want every visit to feel as easy and stress-free as possible. If you need to complete any forms before your appointment, you can download them below and bring them with you or upload them through the patient portal when available. If you’re not sure which form you need, we’re happy to help.
Consent for 18-Year-Olds
When your child turns 18, their medical information becomes private under HIPAA regulations. If they would like you to continue accessing their records or discussing their care with our team, they must complete and sign this consent form.
Download FormMedical Records Request & Release (English)
Need to request, transfer, or authorize the release of medical records? Complete this form to share protected health information to or from GTPFM and other healthcare providers as requested.
Download FormMedical Records Request & Release (Spanish)
Utilice este formulario para solicitar, transferir o autorizar la divulgación de información médica protegida (PHI) hacia o desde Georgetown Pediatrics & Family Medicine y otros proveedores de atención médica.
ADHD Parent Evaluation
Every child is different. This questionnaire helps us better understand your child’s attention, focus, and behavior so we can provide personalized guidance and determine the best next steps together.
Download FormADHD Teacher Evaluation
Your child’s teacher plays an important role in helping us understand how they learn, focus, and interact at school. Please ask them to complete this questionnaire so we can determine the best next steps together.
Download Form