(276) 634-0010 [email protected]

What You Need to Know and Have For Your Appointment

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A list of your current medications

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Family Medical History

N

Your Medical History

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Form of Identification

N

Insurance Information

N

Registration Forms - see below

Important Forms 

For All Visits

HIPAA Registation Form

DOT Forms

Form MCSA-5875 – DOT Medical Examination Form

MCSA – 5895 – CMV Driver Medication Form

DOT Requirements

Physicals

VA High School League Physical Form 

School Bus Physical

Exceptional Care... Close to Home

Same Day Appointments are Available. Walk-Ins Welcome.

(276) 634-0010

FAX (276) 632-0120

[email protected]

Hours

Monday - Friday
8am to 8pm

Saturday and Sunday
8am - 4pm

1044 E. Church St. Martinsville, VA 24112

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