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Patient Forms 

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Patient Forms

In an effort to make your appointment check-in process smoother and more efficient, here you can find a number of forms that you may fill out in advance of your appointment.

If you are a new patient, you can download the forms below (Adobe Acrobat Reader required). Print and complete the forms, and bring them with you to your first visit.

Sentara Surgery Specialists – Your Connection to Sentara Northern Virginia Comprehensive Breast Center

New Patient Form

Sentara Surgery Specialists (Stafford/Woodbridge)

New Patient Form
Health History Form

If you want to have a medical record transferred from another doctor’s office to your new Sentara Medical Group office, please complete the form below. Likewise, this form can also be used to authorize someone other than you to have access to information about your healthcare status on treatment. Just print and complete the form and bring it with you to your next appointment.

Authorization to Disclose or Release Health Information
For questions about these forms, please call your Sentara Medical Group practice.

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