If you are visiting OrthoVirginia for the first time, or if your information has changed since your last visit, please complete these forms:

• Patient History / Pediatric Patient History
• Patient Check-In Form
• Authorization to Disclose Information
• Notice of Privacy Practices

NOTE: To comply with federal regulations and to ensure the accuracy of our records, we require every patient to update her/his Patient History at least once every 12 months. Other forms updates may be requested as needed. We apologize for any inconvenience this may cause, but we appreciate your understanding and compliance.

Please complete the following forms as needed or as directed by your physician:

• MRI Screening Form
• Medical Records Request

To request medical records, please complete this form and mail it to the address listed below. We charge 25 cents per page to process medical records. You will receive an invoice along with your records from our medical records processor, HealthPort.

OrthoVirginia
Attn: Jasmine/Medical Records
1115 Boulders Parkway, Suite 200
Richmond, Virginia 23225

Forms by Physician