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Patient Forms

Instructions:

  • Complete and sign form(s). 

  • Email to info@aacva.com or fax form(s) to 540-343-7349. 

New Patients will receive the entire new patient packet to complete via a contactless registration link sent by email or text about a week prior to your appt. If you would prefer not to complete electronically, you may print and complete the forms from this page and send them via email or fax or bring with you to your appointment.

 

If you would like, we will gladly send you the new patient packet via USPS.

This packet includes the Patient Information Sheet, Evaluation, Practice Policies, and Authorization for Use of Disclosure of Information. 

Please print out this document and return it to our office if any of your personal information has changed since your last visit. You can also update your information on our Patient Portal

This form authorizes us to release your Personal Health Information (PHI) to another provider or entity, like a school or daycare. A signed copy is required for us to release your information to anyone besides you. 

This includes some additional resources that will help you know what to expect for your first visit. It also includes a list of medications that you should not take prior to testing. If you have any additional questions, our friendly staff is always willing to help. 

If you have been seeing another provider and wish to supply us with your previous medical records, please complete this form. 

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