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    • Home
    • Services
    • Fees
    • Schedule A Visit
    • Our Doctor
    • Forms
    • FAQ's
    • Contact Information
  • Home
  • Services
  • Fees
  • Schedule A Visit
  • Our Doctor
  • Forms
  • FAQ's
  • Contact Information

REQUIRED Forms

All new patients must review, complete, and sign a set of required forms prior to receiving services.


It is most efficient if this can be done in advance of your appointment, so that information can be processed prior to your visit, rendering the visit more efficient for you and our physician.


If our physician agrees to visit without advance completion of the forms, he will bring blank copies of these forms for your completion and signatures on-site at your first visit.


If you have a printer, please print them out, complete them,

and return them by mail, e-mail, or fax in advance of your appointment. 

RETURN TO:

Mail:  332 W Lee Hwy, #251, Warrenton, VA 20186

Email:  Dr.Simpson@DocAtYourDoor.Care

Fax:  540-351-8650


(If you can not print them, please request that we mail you the forms.) 

(These form are the copyrighted property of Doc At Your Door, PLC)

Basic Policies (pdf)Download
Registration (pdf)Download
Clinical Information (pdf)Download
Care Team (pdf)Download
Authorizations (pdf)Download
Privacy (pdf)Download
Medicare Contract (if you have Medicare) (pdf)Download

ADDITIONAL FORMS

The following forms are not required initially, but may needed subsequently in certain situations.

Medical Records Release (pdf)Download

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