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
- Acknowledgement of 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:
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.
Attn: Jasmine/Medical Records
1115 Boulders Parkway, Suite 200
Richmond, Virginia 23225
Forms by Physician
To access the necessary forms, please find your doctor’s name in the list below and then click on the name of the form. If your doctor is not listed here, then you may be asked to complete additional forms on the day of your visit.
Dr. Joseph Kim: Pain Form
Dr. Rick Placide: Back Form
Dr. Charles Vokac: Pain Form
Dr. Chris Young: Shoulder Assessment Form
Dr. Jay Desai: Hand Assessment Form
Dr. J.E.B. Stuart: Post-Operative Instructions