Patient Forms

Below are common forms you may need at Sentara Martha Jefferson Hospital. If you have questions about forms, please talk to your healthcare provider.

Forms You May Need

Advance Medical Directive

Sentara Healthcare and the Sentara Center for Healthcare Ethics are offering the community the opportunity to complete their Advance Care Plan (Advance Directive) and register it, free of charge, with our national Advance Directive Registry through the U.S. Living Will Registry. Where ever you go in the United States your Advance Care Plan will be accessible by healthcare professionals when needed to guide your medical care if you are unable to communicate your wishes or make your own decisions.

Hospital Authorization for Release of Medical Information

You will need this to submit this form to request paper medical records.

Primary and Specialty Care Release of Medical Information

You will need this form to give authorization to release or exchange incoming medical records.

Additional 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.


Contact Us

How can we help you? Learn how to contact us.