Patient Forms

In an effort to make your appointment check-in process smoother and more efficient, here are a few of the common forms that you may fill out in advance of your appointment.

Forms You May Need

Primary Care Appointment Paperwork

Please print and complete this form and bring it with you to the first visit to any of our family medicine practices.

Specialty Care Appointment Paperwork

Please print and complete this form and bring it with you to the first visit to any of the following locations: Sentara Southern Virginia Orthopedics, Sentara Southern Virginia Ear, Nose & Throat, Sentara Halifax Neurology, Sentara Halifax Urology, Sentara Southside Hematology & Oncology, Sentara Halifax General Surgery, Sentara Halifax Emergency Physicians or Sentara Halifax Anesthesiology.

Dental Care Appointment Paperwork

Please print and complete this form and bring it with you to the first visit to Sentara Halifax Dental Clinic.

Financial Assistance Application

Print and complete this form to apply for financial assistance in paying your Sentara Dominion Health Medical Associates bill.

Contact Us

Have a question? Call Sentara Dominion Health Medical Associates at 434-517-3932.

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