Office and Financial Policies
New Patient Forms: 
School Forms:
Medical Record Release Form:
Montgomery County Public School Forms:
‚ÄčAuthorization to Administer Prescribed Medication Release and Indemnification Agreement
Authorization to Provide Medically Prescribed Treatment Release and Indemnification Agreement
Emergency Care for the Management of a Student with a Diagnosis of Anaphylaxis
Health Inventory
Infant Formula Waiver/Breast Milk Feeding Plan
Maryland Department of Health and Mental Hygiene Immunization Certificate
Medical Card for Athlete
Physical Education Physician Contact Form
Pre-Participation Physical Evaluation for Athletics
District of Columbia Public School Forms:
Universal Health Certificate
Oral Health Assessment Form
Annual Student Enrollment Form
Medication and Treatment Authorization Form

Asthma Action Plan

Action Plan for Anaphylaxis

Maryland State Department Of Education Office of Child Care:
Health Inventory
Notice of Privacy Practices
The health and privacy of each of our patients are very important to Coleman Pediatrics. As of May 15, 2016, our Privacy Policy Notice and Patient Registration forms have been updated. New forms will need to be signed for each patient at or before their next office visit. To save time in the office, you may login to your Patient Portal account to download the required forms (Patient Registration, Privacy Notice, and the Office Financial Policies) and bring the signed forms with you to the office. These forms can be found in the Patient Portal under "Appointments" and then "Medical Forms". You are able to toggle between patient names to access these forms to repeat the process for each family member in the practice. If you do not have a Patient Portal setup, or have trouble accessing your Patient Portal please contact the office for assistance. Your patience and cooperation are appreciated as we update our patient information and office policies.
**To print Patient Registration you must login to your patient portal account**
Medical Record Release Form