New Patient Electronic Registration and Submission

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There are a few key forms that can be completed electronically using Adobe pdf readers (downloadable for free). Remember to print out the forms after typing the info in. Keep in mind that though you may electronically sign the forms, our office policy requires you to co-sign the forms by hand when you arrive for your appointment. These forms include:

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DOWNLOAD: New Patient Registration Forms (4 pages)
(Click here to read the privacy notice.)

IF you are seeing us for allergies, complete this form


Download, fill out all fields and print the document.

You have the option of faxing the document to us at 540-347-5224. Please remember to physically cosign all signature boxes. Otherwise, please remember to bring the forms with you to your appointment.

Please arrive at least 15 minutes before your appointment in order for us to copy your insurance cards, collect any co-payment, and to make your file. Be aware that some insurance companies require a referral authorization from your primary care doctor in order to be seen by a specialist. Make sure this authorization is sent to us by your doctor PRIOR to your appointment!

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Other Forms That Need to Be Completed By Hand
(If applicable)

If you have no health insurance, complete this form and bring with you

IF you desire allergy testing, read & sign this form

IF you are seeing us for dizziness, complete this form


Remember to bring the following items to expedite your first visit with us and PLEASE give these reports immediately to the check-in person so we can get them scanned into our medical records (prevents check-out delays).

  • All the above forms
  • List of all your medications
  • CT and/or MRI scans (BOTH the actual films and report)
  • Sleep study reports
  • BRING your actual health insurance card
  • Referral authorization sent to our office PRIOR to your appointment (if applicable)

If you need to obtain, send, or transfer medical records from another office, please print out our release form.

Forms for audiology & hearing aid services are here depending on the problem.

 

Any information provided on this website should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment. Advertisements present are clearly labelled and in no way support the website or influence the contents.