New Medical Patients
We accept new patients for primary medical, pediatrics, and women’s health care (including family planning). As a Patient-Centered Medical Home, patients are at the center of a team of health care professionals partnering together to make informed decisions.
How to Register
To register as a new medical patient, please complete the printable patient application and applicable forms which include the following:
- Printable Patient Registration Form (one per patient)
- Patient Registration Form with Sliding Fee Discount
- Patient Registration Form with Support (for patients with no income source)
- Release of Information for transferring or releasing medical records (if applicable)
- Sliding Fee Discount Program Application (If applicable)
- Statement of Support (For patients with no source of income)
- Income Verification Form (For patients that do not receive pay stubs)
- Self-Employment Verification Form (If applicable)
Print completed registration forms and deliver in person, fax to (855) 806-0826, or mail to 25 Northridge Lane, Lexington, VA 24450.
Formas en Español
- Formulario de Registro del Paciente
- Liberacion de Informacion de HIPAA
- Solicitud para asistencia financiera – Programa de Escala Móvil
- Declaración De Apoyo (para pacientes sin fuente de ingresos)
- Vericación de Ingresos
- Formulario de Verification de Autoempleo
- Responsabilidades y Derechos del Paciente
- Aviso de Prácticas de rivacidad