Village Family Practice

We will maintain viable, effective, high- quality external relationships with specialists, hospitals, and managed care entities.

Office Forms

You can save time by downloading the following information and filling out the necessary paper work prior to your first visit.  You will need Adobe Reader to view the documents. Please complete  “Our Payment Policy” and the following forms “Patient Registration Form” “Health History Questionnaire” “Financial Policy” and bring them signed and completed to your appointment.  You may keep the other two handouts for your reference. 

· Patient Registration Form

· Health History Questionnaire

· HIPPA/Financial Policy

· Privacy Practices

· Records Release Form

· Formulary Benefits Data Consent Form

· Map to Village Family Practice