PATIENT REGISTRATION MATERIALS:

Print out, complete, & return the following forms to our Center AT LEAST 2 DAYS PRIOR TO YOUR APPOINTMENT:

• PATIENT REGISTRATION INFORMATION
• MEDICAL HISTORY
• CONSENT TO THE USE OF HEALTH INFORMATION
• NOTICE OF HEALTH INFORMATION PRACTICES
• NOTIFICACIÓN DE PRÁCTICAS DE INFORMACIÓN (For Spanish-speaking patients only)

DUE TO THE INCREASED TIME INVOLVED IN CREATING/UPDATING YOUR ELECTRONIC MEDICAL RECORD, FAILURE TO RETURN FORMS AT LEAST 2 DAYS PRIOR TO YOUR APPOINTMENT MAY RESULT IN THE NEED TO RESCHEDULE YOUR APPOINTMENT!

Forms may be hand-delivered or mailed to:

1885 Port Republic Road  Harrisonburg, VA  22801

Forms may be faxed to:

540-433-6605

E-mail (unsecure, not recommended):

br6613@ntelos.net