PATIENT INFORMATION

MAKING AN APPOINTMENT

Office visits are by appointment only. Out of respect for those with scheduled appointments, it is not possible to see walk-in patients. Return appointments normally will be made as you are leaving the office.

If you have any questions regarding scheduling, do not hesitate to ask the receptionist at 804-264-4545

PREPARING FOR YOUR VISIT

• Please arrive at least 15 minutes for your scheduled appointment.
• Bring your insurance cards, photo ID, and any required referrals.
• Your copay will be collected at the time of your visit.
• If you have a high deductible plan, a $100.00 deposit is required at your first visit.
• Please complete your New Patient paperwork prior to your visit. You have the option of completing on-line, or print the PDF and bring to your visit.

Patient registration packet

• Patient registration packet [PDF] [Online form]

TREATING A MINOR (If applicable)

Consent to treat a minor [PDF][Online form]

• A parent or legal guardian must accompany their minor to the first appointment.
• A consent to treat a minor form must be on file if the minor will not be accompanied by and parent or legal guardian.

MEDICAL RELEASE REQUEST (If applicable)

• Medical Records form [PDF][Online form]

Financial Policy

• Financial Policy Form [PDF]

If you need to request your medical records it must be in writing, dated and signed by the person making the request, and include a reasonable description of the records sought. If someone is making a request on your behalf, he or she must provide evidence of the authority to receive the records (such as power of attorney).

Upon receipt of the request, the provider has 15 days to do one of the following:

• Provide copies of the records;
• Inform the requester if the information does not exist or cannot be found; or
• Inform the requester of the provider who now maintains the records;

ADOV will maintain patient records for a minimum of six years following the last patient encounter barring any other exceptions where ADOV is required to maintain them for longer.

CANCELLATION POLICY:

Please inform us 24 hours in advance if you cannot keep your appointment, so that time can be given to another patient. Occasionally, it may be necessary to reschedule a visit, and every attempt will be made to do so at your convenience. There will be a $50.00 fee for missed appointments unless canceled 24 hours in advance.

QUESTIONS ABOUT YOUR BILL:

Our billing department is available to answer you questions from 8:00 a.m. to 5:00 p.m. Monday-Friday. (804) 264-4545, Option 3