Patient Forms

Here you will find many of the forms we use in our practice. As a convenience and time savings, please complete and print out all of the forms that may pertain to you and bring them to your appointment.

New Patient Forms


New patients who need their medical records from your previous provider(s) transferred, please fill out this form.


Release of Information – Obtaining copies of your Rappahannock Family Physician record

Rappahannock Family Physicians has partnered with MediCopy Services, Inc. to handle all medical records requests. To request your medical records, please follow the link and either submit online or print:

Submit an online authorization

The print copy form can be submitted by the following methods:


Fax: 615-780-9866

Mail: PO BOX 331787 Nashville, TN 37203

In Person: Drop the completed form off at your doctor’s office


Records will be sent within 48 hours of the receipt of the request via the delivery method indicated.