Patient Forms

Below are common forms you may need at Sentara facilities. For more information, contact your health care 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.

Authorization for Release of Medical Information

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

Maternity Pre-Admission Form

At the beginning of your third trimester, we encourage you to pre-admit your hospital stay. This ensures your information is in our system before your special day arrives.

Sentara Medical Group New Patient Form

If you are a new patient for a Sentara Medical Group practice, download this form. Print and complete the form, and bring it with you to your first visit.

Sentara Medical Group Authorization to Disclose Protected Health Information

If you want to have a medical record transferred from another doctor’s office to your new Sentara Medical Group office, please complete this form. 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.

Contact Us

For more information or to make an appointment, call 703-523-1560703-523-1560.