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. PHI Authorization 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, night and weekend appointments available.

Contact Us

  • Phone: 434-237-8886
  • Fax: 434-239-6807
  • Billing & Insurance: 455-5286
  • Toll-Free: 1-800-245-7011 (24 hours)
  • Address: 1212 McConville Road Lynchburg, VA 24502

Contact Us

Send Us an Email

Our Location

Find us on the map