Virginia Physicians, Inc.

Virginia Physicians, Inc.
Corporate Office Building
4900 Cox Road, Suite 155
Glen Allen, VA 23060

Administrative Phone Numbers:
Office: (804) 726-8571
Fax: (804) 726-8574

Administrative Office Hours:
Monday through Friday:
8:30 a.m. to 5:00 p.m.

 

Midlothian Family Practice

Forms & Registration

 

The following set of PDF forms are available for download as a convenience to our patients. You may download, save, and print these forms for your reference or handwritten completion prior to your appointment in order to speed up your visit and minimize your wait times.

 

Authorization for Records Release   

 

New Patient Registration 

 

Consent for Treating a Minor

 

Medicare Wellness Form

 

New Patient Registration (Espanol)

 

HIPAA Disclosure Form (Espanol)

 

 

Make a Secure Online Payment

  To make a payment, please enter the Patient Account Number and Patient Name in the box and click the “Pay Now” button. You will be directed to our secure payment page. Thank you!    

Patient Account Number/Name: “123456/John Doe”

Our Evening and Imaging Hours have changed!

Beginning January 1, 2020, Imaging services will be available at the Westchester location only (Monday – Friday 8:30 a.m. – 5:00 p.m.)

Evening Clinic hours have moved from Westchester to the Village location. Evening appointments are available from 6:00 p.m. to 8:00 p.m Monday – Friday.