Pediatric associates of alexandria

Phone & Fax Numbers for All Locations
Phone: 703-924-2100 | Fax: 703-922-6067
Inova Healthplex Office
6355 Walker Lane, Ste 401, Alexandria, VA 22310
Potomac Yard Office
3600 S. Glebe Rd., Ste 150, Arlington, VA 22202
Duke Street Office
2747 Duke Street, AAlexandria, VA 22314

OPEN 7 DAYS A WEEK!

Inova Healthplex: Mon-Thu: 6am-8pm | Fri: 6am-6pm | Sat: 8am-12pm | Sun: closed

Potomac Yard: Mon-Thu: 6am-8pm | Fri: 6am-6pm | Sat: closed | Sun: 8am-12pm

Duke Street: Mon-Thu: 6am-8pm | Fri: 6am-6pm | Sat: closed | Sun: closed

Inova Healthplex
6355 Walker Ln, Suite 401
Alexandria, VA 22310

Potomac Yard
3600 S. Glebe Rd, Suite 150
Arlington, VA 22202

Duke Street
2747 Duke St
Alexandria, VA 22314

CALL
connect with us

703-924-2100
Open 7 days a week!
Appointments

Home
Appointments
About
- About PAA
- PAA Gives Back!
- Latest News
- Our Blog
Providers
- - Kathleen O. Parente, MD
  - Michael J. Hopper, MD
  - Samantha Ahdoot, MD
  - Andreas D. Sideridis, MD
  - Anne B. Kernan-Grunzke, MD
  - Marie Dierks, DO
  - Mary Jane Bryant, MD
  - Linda George, MD, IBCLC
  - Lowry Shropshire, MD
  - Minal M. Bhojani, MD
  - Allison Waller, MD
  - Jamie Zakkak, MD, IBCLC
  - Ramzi Shaykh, MD
  - Camila Espinal, MD
  - Jean He, MPH, MD
  - Alecia (Allie) George, MD
  - Eileen Mood, CPNP, IBCLC
  - Frank D. Tardo, CFNP, AE-C
  - Lauren Dailey, PA-C
  - Karen Johnson, MSN, CPNP
  - Virginia Cinzano, PA-C
  - Alyssa Jones, CFNP
  - Suzanne O'Brien, CFNP
  - Kelley Shirron, CPNP
  - Caitlin Kelly, CPNP
  - Mary Heinz, CPNP
  - Meghan Seaman, CPNP
  - Sydney M. Vishneowski, CFNP
  - Alexandra Grabowsky, CPNP
  - Kevin Maneffa, PA-C
  - Karen Browning, CPNP
  - Amy Doering, PA-C
  - Kattie Moua, CFNP
  - Brianna Nolan, CPNP
  - Julia Ritch, PA-C
  - Hannah Jones, CPNP
  - Abigail Evans, CFNP
  - Stephanie Pomales, LCSW
Services
- Telemedicine
- Prenatal Visits
- Lactation Support
- Well-check Exams
- Sick Visits
- Travel Clinic
- Asthma
- Developmental Pediatrics
- Mental Health
Forms
- Patient Forms - Packets & Individual
- School, Camp & Daycare Forms
- Escuela, Campamento, Formularios de Guardería
- Screening Forms
- Forms for Developmental Pediatrician
- Forms for Solution-Focused Therapy
- Medical Records Release
- Specialists Referrals
- Parent Survey
- Notice of Privacy Practices
Resources
- Antibiotic Commitment
- Immunization Policy
- Medication Dosing
- Symptom Checker
- Divorce, Separation, & Custody Agreements
- Commonly Asked Medical Advice
- Community Resources
- Online Resources
- Video Resources
Locations
- Potomac Yard Office
- Inova Healthplex Office
- Duke Street Office
- Hospital Affiliations
Contact Us
- Appointment Request
- Emergency & After Hours
- Insurance, Fees, & Billing
- Pay Bill Online
- Comments Form

Patient Forms

Weighing a baby at Pediatric Associates of Alexandria

Our forms process is now electronic and can be completed throughout patient portal.

We ask that new patients contact our office to schedule their first appointment. At that time, our staff will give you access to our patient portal. Through our patient portal, you will complete the remaining paperwork, which our staff will guide you through; additionally, you can view your child's entire medical records, send direct messages to triage nurses and schedule sick and well-check appointments. Please arrive 20 minutes early for your initial appointments.

Completing necessary paperwork online prior to your child’s visit helps quicken the check-in process.

Forms Packets

Newborn Information Packet (New Patient)
New Patient Information Packet

Individual Forms

COVID Vaccine Consent Form, Pfizer EUA, Moderna EUA
Telemedicine Consultation Form
Prenatal Forms
Authorization for Treatment (In absence of Parents/Guardians)
Financial Policy

School, Camp & Daycare Forms

Pediatric Associates of Alexandria has made our school, camp, and daycare forms an entirely electronic process for our patients. We will no longer accept forms dropped off, emailed, mailed, or faxed to the office. We encourage you to bring any form(s) needed to your child’s well check appointment which will be done for free at that time.

Pediatric Associates of Alexandria ha hecho que nuestros formularios de escuela, campamento y guardería sean un proceso completamente electrónico para nuestros pacientes. Ya no aceptaremos formularios entregados, enviados por correo electrónico, por correo postal o por fax a la oficina. Lo alentamos a que traiga los formularios necesarios a la cita de control de bienestar de su hijo, que se realizará de forma gratuita en ese momento.

We will no longer accept forms that are emailed, dropped off, or faxed to the office.

Access Online Forms

Additional Forms

Screening Forms - Vanderbilt ADHD Forms, Scared Patient AKG (Anxiety Related Disorders), M-Chat R/F (Autism), Behavioral Health forms for Therapy, PHQ9 (Depression)
Forms for Developmental Pediatrician (Dr. Shropshire)
Forms for Solution-Focused Therapy
Medical Records Release
Specialists Referrals
Parent Survey
Notice of Privacy Practices