New Patient Information


Getting Started

  1. 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.
  2. Schedule an Appointment
  3. 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.

Divulgación de Registros Médicos



Payment & No-Show Policy

Política de Pago y Ausencia

Sliding Fee Program Application

Solicitud para el Programa de Tarifas Móviles

Medication Assistance Program Application

Solicitud de Ayuda con Medicamentos

Portal Preguntas Frequentes

Patient Access to Medical Records (PHI) Through the Patient and/or Proxy Portal

Acceso del Paciente a los Registros Médicos (PHI) a Través del Portal del Paciente y/o Representante

Revoke Proxy Access Form

Formulario Deacceso de Proxy de Revoke

Galax City Schools Forms

School Based Patient Registration and Consent Packet

Formulario de Registro y Consentimiento del Paciente



Student Consent Form for Current Patients

Elk Creek Rescue Squad Telehealth Patient Registration