Medical Release Form

Authorization for Release of

Medical Record Information

For any child participating in summer activities, it is required for you to have a physical May 1st  of the current year through June 30 of the succeeding year. 
Please see your school for the correct form.

All forms take 2-3 business days to be completed!

703-753-6184  Gainesville

703-361-7131  Manassas

Crestwood Pediatric