Can Someone else bring my child?Document TransmissionHospital AffiliationNew PatientsNewbornsPatient RecordsPatient RegistrationPractice PoliciesPrenatal VisitsSports and ExtraCurricular ActivitiesWhat to Know About School
Piedmont Pediatrics must receive permission from a child’s parent or legal guardian before providing treatment for an injury or illness that is non-life threatening. If the “Permission to Treat” information is not on file with us or presented by the party (baby-sitter, relative, friend) accompanying the child, Piedmont Pediatrics will contact the child’s parent or legal guardian before he or she is seen by the physician. The Permission to Treat form is available for download on our Forms page. A simplified Permission to Treat is also provided on the Registration form.
We can accept information from you via email to or via facsimile to 434-975-7774. Please be aware that email is not secure, so any document you send will be at your discretion. Personal Health Information (PHI) Documents should be sent to us via secure fax or regular mail.

At Piedmont Pediatrics, patient privacy is important. We cannot send any Personal Health Information via email or insecure fax. Documents containing secured information must be picked up in person at our office. Please provide a stamped, self-addressed envelope if you would like documents mailed to you.

We provide newborn and in-patient care at Martha Jefferson Hospital. Our pediatricians have a close working relationship with the physicians at the University of Virginia Hospital. While we are able to follow the course of a patient who is hospitalized at UVa, we do not personally admit patients to UVa.
Before you schedule an appointment with a provider, we need some information from you so we can set up your account and populate your patient chart(s). The first thing we will need is a Registration form, which can be obtained from our Forms page.  Once you have completed the Registration form, we would like a copy of your medical history. If you already have a copy of your medical records you can deliver them to us directly.  Otherwise, you can download and complete our Records Request form and we will obtain a copy from your previous provider.  If at all possible it is best to complete this form at least two weeks prior to your first appointment.  It’s also a good idea to verify that we participate with your insurance policy.  You can find those details on our Insurance Information page.  Your preparations help ensure that you are seen quickly and have all of your needs met.
Our physicians work directly with Martha Jefferson Hospital. At the time of your delivery, simply inform your labor nurse that you have chosen Piedmont Pediatrics as your pediatric practice or mention one of our physicians by name. The nurses will then notify our provider on call, and we will begin seeing your newborn in the hospital. We do attend deliveries that are urgent/emergent. You will still need to complete the patient registration form from our Forms page. We recommend filling the form out in advance, less the new child’s name so it will be ready for your first visit.
If you would like a copy of your medical records, please use our “Records Release Form” form, available for download on our Forms page. Depending on the request, this can take some time. Please complete the form and deliver it to the office as soon as possible.
Our patient registration form must be completed each year. We understand that repeating this process annually is inconvenient, but insurance and HIPAA regulations require that we confirm and update all of this information every year. Please download the Registration form from our Forms page and complete it prior to your first visit of the calendar year or arrive 15 minutes early to complete it in the office.
Our providers do not currently schedule face-to-face prenatal visits. If you would like to speak to one of the physicians please call our office. You may leave a message and a provider will return your call to answer any questions you may have prior to delivery.

The Virginia High School League (VHSL) requires the completion of their physical form prior to athletic participation. You must have a physical exam after May 1 of the upcoming school year to meet the criteria. It is best to book these appointments as early as possible to ensure that your child will be allowed to participate. You will need to give your nurse a copy of the Athletic Participation/Parental Consent/Physical Examination Form with your portion (first page) completed when you come for your appointment. Please make sure you have completed the first page prior to the visit. You will find a link to the VHSL form on our Camp and Sport Forms page.

There are many other programs that require medical paperwork. In the event that you need us to complete other documents, please submit the forms to our office with enough time for us to fill them out before the deadlines. Most forms can be completed within 48 hours.

The state of Virginia requires (Ref. Code of Virginia ~ 22.1-270) “that your child is immunized and receives a comprehensive physical examination before entering public kindergarten or elementary school.” We have a set number of Well Child or Physical Exam appointments allotted each day and they fill up quickly as the school season approaches. It is best to book those appointments as early as possible to ensure that your child does not miss any school. You will need to give your nurse a copy of the Virginia State School Entrance form with your portion (first page) when you come for your appointment.  You will find a link to the form on our Local School Forms page.