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)

**For School Form requests outside of scheduled appointments, please drop them off in person or submit them through the patient portal. Payment of fees can be made by phone or in person (Credit Card only). Once both the form and payment are received, the completed form will be available within 5 business days **

• Please be aware that Forms Requests outside of scheduled appointments can only be completed if the Patient has been seen after January 1, 2024. If patient has not been seen after this date, they will be required to have an appointment to complete forms. If medication refills are needed no drop off option available, an appointment is required.
• 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.
• Please note: If a patient was seen by a provider in 2025, no charge to submit School Form.
• Completed forms will be submitted to the patient portal or available for pick up. Payment may be made over the phone or in person. Credit Card only.

Pricing:  *(Credit Card only. Paid at the time of Document Drop Off)*

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Form Fees

• School/Daycare forms $20 per patient. All required school forms are considered a single form fee per child.
• Accessory forms – sports, camp and after school forms will be charged a separate fee of $20 per child
• Forms will be Completed within 5 Business days