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New Patient Registration, Information, and Other Forms


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Optionally, you can also download the electronic pdf version you can type in rather than the plan pdf which you have to handwrite. Make sure to complete and print the entire patient registration form (4 pages)! Also bring with you to your appointment the following to help speed things along. PLEASE give these reports immediately to the check-in person so we can get them scanned into our medical records (prevents check-out delays)

If able to, faxing (540-347-5224) the paperwork and any other relevant reports (sleep study, MRI, CT, etc) to us >24 hours prior to your appointment would be most helpful. This will help speed things along when you arrive for 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 BEFORE your appointment!

Here are some other forms that may also apply depending on your symptoms and situation:

As an FYI, Fauquier Hospital also offers online pre-registration for any studies (CT and MRI scans), tests (bloodwork), and procedures (surgical) that may be performed there.