Planning Your Visit to PASC

At the Pediatric and Adolescent Sleep Center (PASC), new patients are seen by our Sleep Physician Specialists on an appointment basis. Please CALL us at (703) 226-2290 to make an appointment and we will work with your physician’s office to help obtain referral information.

At the Pediatric and Adolescent Sleep Center, we strive to make the registration process as straight-forward as possible for new and returning patients. Instructions about completing the registration process, including online registration, will be provided to you when you schedule the first appointment.

A parent or guardian must be present with the patient during all visits to the Pediatric and Adolescent Sleep Center for patients under 18 years old.

Preparing for Your Child’s Consultation/Office Appointment

Please bring to your appointment:

• Registration materials as directed
• Current health information card(s) for the patient
• Proof of identification
• Copay, if applicable

New Patient Forms

New patients are registered in our system and important patient forms are completed prior to their first appointment.

You may bring these forms with you to your initial appointment:

• Patient Registration Form English | Spanish
• Notice of Privacy Practices English | Spanish
• Consent to Treatment/Acknowledgement of Receipt of Notice of Privacy Practices (for parent/guardian of a minor child) English | Spanish
• Consent to Treatment/Acknowledgement of Receipt of Privacy Practices (for adult patients) English | Spanish
• New Patient History Form English | Spanish
• Pediatric Symptom Checklist English | Spanish
• Patient Portal Proxy Form  Portal-English | Spanish

If you are an established patient, please bring these forms to your appointment:

• Interval History Form Interval History – English |  Interval History – Spanish
• Pediatric Symptom Checklist English | Spanish

Additional Consent Forms

• Medical Permission Form English | Spanish
• Authorization to Use and/or Disclose Protected Health Information Form with instructions English | Spanish
• Request to Review and/or Obtain a Copy Protected Health Information (PHI) Form with instructions English | Spanish

Preparing Your Child for a Sleep Study

A sleep study, also called polysomnography, is a test used to diagnose sleep disorders, or may be used to adjust the treatment plan if the child has already been diagnosed with a sleep disorder. A sleep study is a non-invasive test which is conducted at night in our sleep center. Our sleep centers are 100% dedicated to and designed for young people under age 21 years and his/her parent or guardian.

Sleep Study Information Sheets

• Sleep Study FAQs PSC Sleep Study FAQs-English | Spanish

Sleep Study Only Forms

If your child is having a sleep study only without an office visit , please fill out and bring the following forms:

• Patient Registration Form English | Spanish
• Notice of Privacy Practices English | Spanish
• Consent to Treatment/Acknowledgement of Receipt of Notice of Privacy Practices (for parent/guardian of a minor child) English | Spanish
• Consent to Treatment/Acknowledgement of Receipt of Privacy Practices (for adult patients) English | Spanish
• Sleep Log (Please fill this out 2 weeks prior to your child’s sleep study.) English | Spanish