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Patient Information

Forms for New Patients

If you are a new patient for a Sentara Medical Group practice, you can download the appropriate form below (Adobe Acrobat Reader required). Print and complete the form, and bring it with you to your first visit.

 Adult Patient
 Pediatric Patient
 History and Physical (PDF file, Print and bring to your appointment)

For questions about these forms, please call your Sentara Medical Group practice

 Access the Personal Electronic Medical Record of a Spouse or Parent
(Please note: You are required to complete and sign this form and give it to your physician practice.)

MyChart Proxy Request Form (PDF)

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