Patient Forms
Instructions:
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Complete and sign form(s).
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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, Financial Policy, Privacy Policy, and Authorization for Use of Disclosure of Information.
This document outlines how we handle your personal health information.
New Patients: Please review this document before signing the acknowledgement form in the New Patient Packet.
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.
This policy outlines our financial policies and your financial responsibilities. If you have any questions about the policies, please feel free to call our office.
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. A signed copy is required for us to release your information to anyone besides you.
If you are transferring from another allergist, sign this form and include it with a request to your previous provider for your records to be transferred to us.