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patient information

What to bring to your initial appointment

Forms to be completed

Insurances we accept

Prescription Refill Request Form

INITIAL APPOINTMENT
To make certain that you receive the time and attention required to provide optimal care, we ask that new patients arrive 15 minutes prior to their first appointment to complete the necessary registration process.

New patients are requested to bring their initial appointment:

• Insurance card
• Referral forms and co-payments
• Copies of pertinent diagnostic tests and medical records
• All current medications
• Completed Patient Registration form, Medical History form and Physical form (if available)

To help us provide you with optimal care, if you have been hospitalized or had cardiology testing at another facility, please have copies of the reports sent to our office prior to your initial visit.

PATIENT FORMS
NOTE: The following forms are Adobe PDF files. You will need Acrobat Reader to view (get the Reader plug-in if you don't have it).

Please print forms, fill out and bring in with you for your initial appointment.

Patient Registration
New Patient Medical History
Treatment and Payment Policies
Permission to Release Medical Information
Consent to Use and Disclosure of Protected Health Information
Notice of Privacy Practices (HIPPA)
Written Acknowledgement
Advance Beneficiary Notice

INSURANCES WE ACCEPT
Aetna
Alliance PPO
Anthem Blue Cross/Blue Shield
Anthem Healthkeepers
Champus
Cigna
MAMSI
Medicaid of Virginia
Medicaid of North Carolina
Medicare
Optimum Choice
Sentara Optima
Sentara - all products
Tricare
Tricare Prime
Virginia Health Network

Please call the Business office if your insurance is not listed: 757-499-2825.

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