—Patients · Paperwork
Patient forms.
Everything you might need to fill out, in one place — for urgent care upstairs and primary care downstairs. Print at home, complete with a pen, and bring it with you. Each form is a PDF.
—Start here
Every new patient.
Three forms cover your first visit at either practice. If you've been seen before, you may only need to update your registration.
PDF
Patient Registration
First-time visitors fill this out so we have your contact info, insurance details, and emergency contacts on file.
Download ↓
PDF · Fillable
HIPAA Acknowledgment & Consent
Consent for treatment and our notice of privacy practices. You can type directly into this one before you print it.
Download ↓
PDF
Financial Policy
How billing, copays, self-pay rates, and outstanding balances work. Please review and sign before your first visit.
Download ↓
—Physicals
Sports, DOT, and School Bus Driver.
Bring the completed form with you — we can't finish the exam without it. Fill out your section ahead of time and the visit goes much faster.
PDF
VHSL Sports Physical
Required for middle and high school sports in Virginia. Parent or guardian fills out the medical history before the exam.
Download ↓
PDF
School Bus Driver Physical
For school bus driver certification in Virginia.
Download ↓
PDF
DOT Medical Examination Report (MCSA-5875)
For commercial driver physical exams. Driver fills out the first section before the exam.
Download ↓
PDF
Medical Examiner's Certificate (MCSA-5895)
The DOT card you'll receive after passing your commercial driver medical exam.
Download ↓
PDF
DOT Physical Requirements
A guide to what's tested in a DOT physical and how to prepare for it.
Download ↓
—Before you come
A few notes on
filling these out.
No printer? No problem — we keep paper copies at both front desks. Just arrive about ten minutes early.
- +Use a pen, and print clearly — especially your date of birth, phone number, and pharmacy.
- +Sign and date anywhere the form asks. An unsigned form has to be redone at check-in.
- +Bring your photo ID and insurance card along with the paperwork.
- +For a physical, bring the completed form with you — we can't certify an exam without it.
- +Filling out a form for a child? A parent or legal guardian needs to sign.
- +Forms open as PDFs in a new tab. On a phone, tap the share icon to save or print.
Questions about a form?
Give us a call — we'll walk you through it.