Practice Forms

Here is our registration package. Please take the time to print out the forms (pdf), fill them out and bring them with you at the time of your new patient appointment.

Registration Form

The Village Doctor, P.C. Notice of Privacy Practices

Acknowledgement of Receipt of the Notice of Protected Health Information

Authorization to Release Health Care Information

School Forms

Here are some commonly used forms needed for school:

Entrance Physical

Sports Physical Form

Medication Administration Form

Vaccine Information Sheets

Important information from the Center for Disease Control on the childhood immunizations we give in our office:

DTaP, Hepatitis B, Haemophilus Influenza Type B, MMR, Pneumococcal (child),

Varicella (chicken pox), TDaP (boostrix), Gardisil (HPV), Menactra (Meningiococcal)

And the immunizations most commonly given in the Travel Clinic:

Hepatitis A, Typhoid, Yellow Fever

Links to General Medical Information

Family Doctor.org

Virginia Department of Health

CDC Website

General Assistance:

Lifeline

Meals on Wheels

Peninsula Agency on Aging

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