ALERT***
We are experiencing a high volume of NEW patient requests that we regretfully cannot accommodate; therefore, in order to take care of our established patients. OFP Orange and Madison offices will TEMPORARILY be unable to accept new patient requests or transfers at this time. Please contact our office at 540-672-3010 to be put on our waitlist or for any questions. We hope you have a great day!
New Patient?
Thank you for choosing Orange Family Physicians to be your health care provider! We want to ensure that your first visit goes as smoothly as possible, so below are forms that we have our new patients fill out. They are documents that you can print at home and fill out prior to arriving. That way we can focus on what is more important when you walk in, and that is seeing you!
Of course if you do not have the ability to print these at home, we will have them at the office for you to fill out!
- Patient History Information Sheet
- Patient Demographics Information Sheet
- Records Release To Orange Family Physicians– Please complete this form to have your previous health records sent to our office for a continuation of care.
- Financial Policy
- Acknowledgement of Receipt of Notice of Privacy Practices (HIPAA)
Additional Patient Forms
- Authorization To Treat Minors Consent Form– Parent/Guardian to complete this prior authorization so that medical care may be delivered directly to minors if a parent or legal guardian cannot be present prior to treatment. (Allows minors to bring self to appointment). Parent/Guardian to complete in order to allow someone other than themselves to seek medical care for their children.
- Authorization for Release of Information-Compound Release– Complete this form in order to give our office permission to provide health care related information to family members such as husband, wife, partner, children, parents, etc.
- Medicare Annual Wellness Visit – Appointment Form and Patient Questionnaire– Complete this form if scheduled for a Medical Annual Wellness Visit only. * Patient will need to be scheduled for this visit before completing these packets.
- Records Release to Another Facility From Orange Family Physicians
- Orange Family Physician Notice of Privacy Practices
- Mammogram Release Form
