Patient Forms

To help expedite your visit at Albemarle Center for Family Medicine, we encourage you to dowload the forms below, print them out and bring them with you! Of course, if you have any questions, please feel free to contact us!

Patient Registration

Authorization for Release of Information

Annual Registration

Health History

Review of Symptoms

School Entrance

School Physical

HIPPA Privacy Notice

Parental Consent for Minor Children

Annual Physical Exam Q&A

Authorization for Records Release

Vaccine Information

Facts for Parents About Autism and Vaccine Safety

To assist members in discussing concerns related to vaccines and autism, the AAP is making available a handout for parents, "Facts for Parents About Autism and Vaccine Safety." This document is available above and is also posted on the AAP public Web site and in the Member Center. Go to Autism Information Page for more information.
 

 


These forms are in .pdf format. If you do not have Adobe's free PDF reader, please click on the button below!