Forms

If you're joining us as a new patient, welcome to the POBC family! We're glad you're here.

POBC is partnering with Phreesia to help save you time when you register for your appointment. You can check-in from any smartphone, tablet or computer and from the privacy of your own home. Registering from your own device saves you time and ensures your information is always up to date. Just make sure we have your current e-mail address and phone number and you can use mobile check-in to make your visit simpler and faster!

Prefer paper forms? Click the link and download our new patient packet.

If you need to request the release of medical records from a previous office or transfer records to a new office, please complete the Medical Release Form. Our team is here to help if you have any questions concerns. Thank you for choosing our office for your healthcare needs.

Coming in for your yearly flu shot? Click the form icon above print & complete the short questionnaire.  Bring it to your appointment and you'll be in and out in no time!

This physical form can be used for grades 1 - 8. 

Please complete the packet prior to your appointment with the physician. 

NOTE:

Please verify with the school what sports form they are requiring. 

The area highlighted in yellow should be filled out by your physician. 

This physical form can be used for grades 6 - 12.  

Please complete the packet prior to your appointment with the physician.

NOTE:

Please verify with the school what sports form they are requiring. 

The area highlighted in yellow should be filled out by your physician.

This form is required for all BCPS students who require  medications (prescription OR over the counter) to be administered at school.

This form is required for all BCPS students with a history of significant allergic reactions. Print this protocol sheet for the new year.

This form is required for all BCPS students with asthma.  Print this asthma protocol sheet for the new year.

If your little-one is 18 - 30 months old and coming in for a checkup, get ahead of the game by completing MCHAT autism screening form above!  Your toddler will thank you!

This form is a screening tool for depression.

The AAP recommends every patient aged 11-18 be screened for risk-taking behaviors.  Allow your child to complete this screening privately and honestly, so we can provide effective and appropriate counseling if needed. 

ADHD Vanderbilt Assessment Scale is for first time diagnosis. Please download & fill out the form for your child's initial appointment. 

ADHD Vanderbilt Assessment Scale for follow-up appointments. Please download & fill out the form for your child's follow-up appointment.

ADHD Vanderbilt Assessment Scale is for first time diagnosis. Please download & have your child's teacher fill out the form for your child's initial appointment. 

ADHD Vanderbilt Assessment Scale is for first time diagnosis. Please download & fill out the form for your child's initial appointment.