New Patients and Patient Forms

Patient Forms

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.

Now Offering Tele-Health appointments per approval from your provider

First Appointment Checklist:

Para ver los formularios en español, utilice los enlaces a continuación.


Website: Click on the image to go to the website   Phone:  540-900-2322.   Email:

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