Thank you for choosing Piedmont Family Practice!
For your first appointment, please arrive at least 15 minutes prior to your appointment to allow for registration and completing the below attached forms. Or, you may print and complete the following forms in the comfort of your home to bring with you and speed up the registration process.
First Appointment Checklist:
- Bring Current ID Card
- Bring Current Insurance Card
- Bring a Copy of Your Current Medication List
- Complete New Patient Form
- Complete Review of Systems Form
- Complete Health History Form
- Complete 2019 HIPAA Form
- Consent to Treat A Minor Form
Para ver los formularios en español, utilice los enlaces a continuación.
- Complete el nuevo formulario para el paciente
- Revisión completa del formulario de sistemas
- HeComplete el Formulario de Historial de Salud
Website: Click on the image to go to the website. Phone: 540-900-2322. Email: Piedmont@rrsmedical.com.
There is no fee to send records to a physician.
Fees for personal records: $6.50 fee for chart w/ electronic delivery. $6.50 + shipping for chart w/ paper delivery. Requests will be completed within 10 days of receipt of the request.
If you would like to download/print the form to fill out, RRS Medical Record Request Form