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. Request for Access to Personal Health Information
    Request for Access to Personal Health Information
  10. School Entrance Form
    School Entrance Form
  11. 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

Practice News

Flu Vaccine In Stock!
August 27th, 2019

We have received our first shipment of flu vaccine – please give us a call at 434-237-8886 to schedule your child’s flu...

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Opening at 9:00 a.m. Wednesday, February 20, 2019
February 19th, 2019

Due to the pending weather forecast, we are planning to open at 9:00 a.m. on Wednesday, February 20, 2019. If you need to schedule an...

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