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All new patients to Sentara Medical Group are asked to fill out the form below before their first appointment. If possible, please complete the form, print and bring it with you to your appointment. To get an even greater head-start, request your activation or log-in to MyChart now to also complete your pre-visit/medical history questionnaire available in the Patient Forms section.
To edit the form on your mobile device, Download Adobe Reader.
If possible, please bring the filled out form with you to your first appointment.