Important Information and Pricing

School District Links

Common School Forms

• School Form and Emergency Medication Request
• Albuterol-School Form
• Benadryl-School Form
• Other Medication-School Form
• Anaphylaxis Plan

NAAC has appointments specifically for Forms Completions Requests available. We suggest to avoid out of pocket fees related to Form Completion Requests please schedule an appointment at your preferred location via our online request HERE or call us at 206-527-1200

• School Form Requests during an appointment will be billed to the Patient’s Insurance and respective copays will be due.
• Forms will be completed at the time of visit
• There are Forms Completion Appointments currently available at all locations (As we get closer to the start of school these appointments will get filled)
• The patient must be present at the time of the appointment
• Please note: Separate appointments required for different patients (Due to Insurance restrictions 2 people can not be seen at the same time)

**All School Form requests outside of scheduled appointments must be dropped off in person and fees must be paid at the time of drop off (Cash or Check only).**

• Please be aware that Forms Requests outside of scheduled appointments can only be completed if the Patient has been seen after September 1st, 2023. If patient has not been seen after this date, they will be required to have an appointment to complete forms.
• All Established Medicaid (CHPW, UHC) recipients are required to schedule appointments for School Form Request, due to Insurance guidelines.
• Please make sure to include the Patient’s School District, Patients Date of Birth, Patients Allergens, Patient’s Weight, and the mode of delivery for Medication, and to fully complete Parent/Legal Guardian Signatures.
• If you would like your child’s school forms to be faxed to your child’s school, please sign the parent section and include the school’s name and fax number before submitting them to us. Unsigned forms can only be mailed to the patient’s home or picked up by a parent/legal guardian.
• Forms will be retained for 90 days after completion. Any service requests beyond this time frame will incur additional fees
• Please note: If a patient was recently seen and has been diagnosed, they have 30 days to submit School Form Request at no charge

Pricing:  *(Cash or Check only. Paid at the time of Document Drop Off)*

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Normal Service:

• $30 Fee for Single Child
• $50 Fee for 2 or More Children
• Forms will be Completed within 10 Business days

Expedited Service:

• $50 Additional fee
• Forms will be Completed within 2 Business days