Patient Forms

With your busy schedule, we know your time is valuable and no one likes long waits at the doctor’s office. So to help minimize your wait time at F. Read Hopkins Pediatric Associates, please fill out the forms below in advance and bring them to your appointment. Remember, we are here for you, so please call us with any questions you may have regarding these forms. We look forward to your visit with us.

  1. Patient Registration Packet
    Patient Registration Packet
  2. Patient Registration Packet – 18 Years or Older
    Patient Registration Packet – 18 Years or Older
  3. Patient Registration Form
    Patient Registration
  4. Patient Registration Form – 18 Years or Older
    Patient Registration Form – 18 Years or Older
  5. Consent Form
    Consent Form
  6. Notice of Privacy Practices
    Notice of Privacy Practices
  7. NPP Acknowledgement
    NPP Acknowledgement
  8. Records Release Form
    PHI Authorization Form
  9. School Entrance Form
    School Entrance Form
  10. Sports Physical Form
    Sports Physical Form

ADHD Forms

Open seven days a week,  weekend appointments available.

Contact Us

  • Phone: 434-237-8886
  • Fax: 434-239-6807
  • Billing & Insurance: 434-455-5288
  • Address: 1212 McConville Road Lynchburg, VA 24502

Announcement

Rachel-Gagen picure

May 1, 2025

After almost eighteen years, Dr. Rachel Gagen is saying goodbye to Hopkins Pediatrics to begin the next chapter in her pediatric career. She has accepted a position at Carilion Clinic where she will teach pediatric residents and students from the Virginia Tech School of Medicine.

While she will be sorely missed by our patients, families, and staff, we wish her all the best as she continues to positively impact those around her, especially future pediatricians and families in our neighboring communities. Best of luck, Dr. Gagen!

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