Patient Forms & Helpful Links

Patient Forms

The following are some forms you may find useful.

New Patient Request Form

Health Risk Assessment

Patients who are coming for a Medicare Wellness Exam should complete this form and bring it with them to their appointment.

Direct Primary Care Intake Form

Patients who are new to our Employer Direct Primary Care program should complete this form and bring it with them to their first appointment along with their photo ID, DPC member card, insurance card, and any prescriptions, over-the-counter medications, vitamins and supplements they are taking.

Diagnostic Center Ultrasound Preparations

Patients who are coming for an ultrasound should review this form in advance, as certain exams require specific preparations.


The following links may offer some useful information to help you make decisions regarding your family health and wellness. Always contact your provider if you have a question about your health care, or about any treatment options available to you. While the Internet is a valuable resource for information, your provider knows you and your family and combines that for a fuller understanding of the facts when determining your treatment options.

External Content Disclaimer

*Please note that pages of this site may be linked to other websites, which may have different terms of use and privacy practices than Privia Medical Group. Privia does not own, control, manage, supervise, direct, or otherwise have involvement in such other websites or the content of such websites. Privia is not responsible for the content of any linked websites. Privia is not acting as an agent for these websites, nor does Privia endorse or guarantee, in any way, their websites, content, or products. Privia makes no representation or warranty regarding the accuracy of information contained in linked websites, takes no responsibility for the use of copyrighted or otherwise protected materials on such linked websites, and has no control over the privacy practices or use of user information at such linked websites.