Call the office at 1-434-582-2273 to schedule a Virtual Visit appointment. At this time, Collaborative Health is not accepting online scheduling for this type of appointment.
Patient Forms
Patient Forms
New Patient Request Form
To establish care with one of our providers, please complete both the New Patient Request form and the Release of Medical Records form. Follow the return instructions provided in the New Patient Request form for both documents. Completing the Release Form will expedite the transfer of your medical records, allowing your current primary care provider to send your records to our office, should you be accepted into our practice.
Health Risk Assessment
Patients who are coming for a Medicare Wellness Exam should complete this form and bring it with them to their appointment.
Pediatric Forms & Questionnaires
Click on the button below to view all of our Pediatric patient forms. These include the new patient packet, safety and risk questionnaire and the ages and stages questionnaire.
ONMM Forms
Click on the button below to view all of our ONMM patient forms.
Administrative Forms
Release of Health Information
CVFP, a division of Collaborative Health, has partnered with Sharecare to fulfill your requests for records. We are committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices. If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID.
This option is for healthcare providers, attorneys, or if you are requesting the medical records for someone other than yourself and are not the legal guardian.
Authorization for Release of Medical Information
Autorización De HIPAA Para Divulgar Información Del Paciente
Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
Authorization and Consent for Treatment
Autorización y Consentimiento Para el Tratamiento
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
Preferred Contacts
Contactos Preferidos
Patients are encouraged to complete and return the Preferred Contacts Form but it is not required.
Virtual Visit Policy
This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
Office Policies
Financial Policy
Política Financiera (PDF)
This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Vaccination Policy
Effective October 1, 2024
Additional Information
Notice of Privacy Practices
Aviso de prácticas de privacidad
Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.