Become a Patient

Patient Forms

The following are forms you will need to complete prior to checking in for your appointment. Please take a moment to print off the forms and complete them before you come to our office so that we may process your information and complete your check-in quickly. Remember to always present your insurance card when checking in for your appointment, and to have a complete list of all medications – both prescription, over-the-counter, and vitamins and health or nutritional supplements – for your provider to review at your appointment.


New Patient

We are pleased to welcome new adult primary care patients to our practice. New patients should contact our office at 434.455.5538 to schedule an appointment. Please be prepared to provide personal information such as your current medications, insurance, and social security number. Our scheduling staff will inform you of the necessary information you will need to bring with you to your appointment. We look forward to serving your health and wellness needs.

We currently do not accept new Medicaid patients to our Internal Medicine practice (adult primary care); however, we may accept Medicaid patients for select specialties. Medicaid patients seeking adult specialty care offered by our practice should please call to see if there is an opening available.

Become a New Patient

We are currently accepting new patients into our practice. Thank you for considering us. To become a new patient:

  1. Make an Appointment
  2. Sign up for our patient portal
  3. Download your patient forms online through the patient portal

When you come to our office for the first time as a new patient, we'll ask you to complete some initial forms, including an Authorization and Consent for Treatment form, if you were not able to download them from the patient portal in advance of your appointment.

To make sure there are no delays in care during your first visit experience, please arrive 15 minutes prior to your scheduled appointment to ensure your registration is complete before meeting with your new provider.

Remember to bring:

  • Your insurance card
  • Valid photo ID
  • List of current medications
  • Office co-pay

In an effort to respect the time of all of patients, our staff strives to stay on schedule so that other patients do not have to wait.

For patients who are delayed and arrive late for appointment, every effort will be made to see them the same day. However, wait times may apply, or appointments may need to be rescheduled.

Privia portal email example

Patient Forms

Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.

Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required.

Office Policies

Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.

HIPAA Privacy Notice