If you are a new patient to our practice or have not seen
one of our physicians in over a year and are scheduled to
see one of our physicians, it is important that you print
these documents and complete them. Since you have not seen
one of our physicians before or it has been awhile since
seeing one of the doctors, they need to get your medical
and surgical history. Also, our practice needs your
address, family physician and other basic registration information.
Please bring the completed Registration forms below to
your first appointment.
| Registration |
|
| Patient Registration (Patient
must update annually) |
|
| Notice of Deemed Consent |
|
Patient Authorization for Use/
Discosure of Healthcare Information |
|
| Written Acknowledgment |
|
| New Patient Medical and Surgical History |
|
| Existing Patient Medical and Surgical
Update |
|
| Patient Request for Medical records |
|
| |
|
| Other Notices |
|
| Notice of Privacy Practice |
|
If you have any questions about these forms, please call
our office at (804) 288-7077.
Patient Rights & Responsibilities
As a patient of our practice, we consider you an important
partner in your healthcare. When you are well informed,
participate in decisions, and communicate openly with your
doctor and other health professionals, you help make your
care as effective as possible. Download
Patient Rights
