BEFORE YOUR VISIT:

Please have all the following ready to bring to your visit:

• Insurance Card
• School Forms (if needed) – Please fill out your portion prior to your appointment.
  Click here for links to Virginia School Forms

* Please note that all new 6th graders at public schools in Virginia will need a new updated school entrance form and vaccine record.

You may want to write down any questions you have for your medical provider, so you may have all your questions answered at your appointment.

LINK TO FORMS:

Please complete the following forms and bring them to your appointment.  Completing these forms prior to your visit  helps your medical providers have more time to spend answering your questions, addressing your concerns, and examining your child.

• Pediatric Symptom Checklist (for PATIENT)
• Pediatric Symptoms Checklist (for PARENT)

VACCINES:

We recommend that the following vaccines be given at the 11-year-old visit:

• Tdap (Tetanus, Diphtheria, Pertussis)
• Meningococcal
• Human Papillomavirus (HPV-9)
• Influenza-Inactivated or  Influenza-Live, Intranasal (if in season)

We recommend the following vaccine be given at the 12 year old visit:

• Human Papillomavirus (HPV-9)  (if 3-part series not completed)
• Influenza-Inactivated or Influenza-Live, Intranasal (if in season)