• PATIENT FORMS
    Alexandria Primary Health care provider
  • PATIENT FORMS

Our friendly and competent staff is dedicated to your comfort and quality of care throughout your visits. We provide the best and latest in medical technology and treatment options. We emphasize maintaining existing healthy habits while improving where medical attention is needed.

Our team emphasizes comprehensive quality care and progressive medical treatments. Please complete and print all four forms before your first appointment. Also, please bring your insurance card, Photo id and all medicine to every visit.

Fillable Pdf Forms 

New Patient Registration Form 

Health Questionnaire Form 

Release of Medical Record 

Office Policy Form 

HIPAA Policy 

There will be a $25 dollar charge for any missed appointments or if you reschedule within 24 hours of your scheduled appointment time.