These forms are in Adobe PDF format. If you don’t have Adobe Reader software, you can download it for free here.
Do you want to become a Medics USA patient? Make your first visit quicker by filling out our New Patient Forms prior to your first appointment. Bring the completed forms to your appointment or fax them to us.
If you want to become a Medics USA patient and are also on Medicaid, then you have an additional form to fill out and bring in — the Advanced Beneficiary Notice. Please just fill in the information needed in the two boxes.
If you need your Medics USA medical records to be sent to another healthcare provider, then you must fill out an Authorization to Release Medical Information.
Anyone needing an immigration physical must bring us a copy of Immigration Form I-693 to your appointment. In black ink, fill in your name, address, and date of birth on the first page. On the rest of the pages, fill in your name and A-number (if applicable). The rest of the form will be filled out by the physician during your examination.
Virginia requires that your child is immunized and receives a comprehensive physical examination before entering public kindergarten or elementary school. Download the Virginia School Exam Form, fill out Part I, and bring it to your child’s physical. Medics USA will complete Part II and Part III of the form. NOTE: This form must be completed no longer than one year before your child’s entry into school.
If your child is involved in a sport that requires a physical, please download the Virginia High School League Athletic Participation/Parental Consent/Physical Form.