New Patient Information
Forms
Getting Started
- Prepare for Your First Appointment:
- To save time, please complete the New Patient Registration Forms below and fax or bring them to our office BEFORE your first appointment.
- If you are transferring your medical records, please complete the “Authorization to Release Information” form (Spanish - Divulgación de Registros Médicos) and send it to your previous provider so that we will have access to your medical records before your first appointment.
- Schedule an Appointment
- Select one of our convenient locations: Cana, Ferrum, Floyd, Fries, Grayson Highlands, or Laurel Fork.
- Call to make your appointment or use our convenient online form
- When You Come for Your First Appointment:
- Be sure to bring along any medication you are currently taking.
- If you are applying to our Sliding Scale Program, bring along ALL of your proof of income information so there is no delay in approving your application.
New Patient Forms/Formularios para pacientes nuevos
Please complete these forms and fax to 276-398-3331 or bring them to our office BEFORE your appointment.
Complete estos formularios y envíelos por fax al 276-398-3331 o tráigalos a nuestra oficina ANTES de su cita.
New Patient Registration Forms
Electronic forms are available for Floyd, Ferrum and Laurel Fork. Please see their location page.
Formularios de Registro del Paciente Nuevo
Los formularios electrónicos están disponibles para Floyd, Ferrum y Laurel Fork. Por favor, consulte su página de ubicación.
Notice of Privacy Practices
Aviso de Prácticas de Privacidad
Other Forms/Otras Formularios
Miscellaneous forms to complete as needed.
Authorization to Release Information
Divulgación de Registros Médicos
____________________