REPORT OF MEDICAL EXAMINATION - Child

  • M.D. have examined
  • and find him/her to be in
  • health. Examination of this child did not reveal any evidence of communicable diseases and his/her immunization are current.

  • The Following tests were administered(if indicated):

                      

    Results/Date

  • The following medications were prescribed:

OFFICE ADDRESS:

124 Amherst St Winchester, Virginia 22601

PHONE NUMBERS:

Winchester – (540) 532-3272

Fairfax - (703) 200-9099

Charlottesville – (434) 825-1162