PatientFirst
  • Services
    • Urgent Care
    • Primary Care
    • X-rays
    • Lab Testing
    • Prescription Drugs
    • Immunizations
    • Occupational Health
    • Conditions Our Providers Care For
  • Locations
    • Locations near me
    • South Jersey Area
    • Eastern Pennsylvania Area
    • Central Pennsylvania Area
    • Baltimore and Surrounding Areas
    • Greater Washington, D.C., and Fredericksburg Areas
    • Richmond and Surrounding Areas
    • Hampton Roads/Tidewater Area
  • Find a Physician
  • Insurance & Self-Pay
    • Maryland Insurance Participation
    • New Jersey Insurance Participation
    • Pennsylvania Insurance Participation
    • Virginia Insurance Participation
    • Maryland Self-Pay
    • New Jersey Self-Pay
    • Pennsylvania Self-Pay
    • Virginia Self-Pay
  • For Employers
    • Overview
    • Health Services
    • Forms & Resources
    • DOT Physicals
    • DOT Examiners' Schedules
  • Home
  • Health Matters Blog
  • FAQ & Resources
  • Careers
  • Contact Us
  • My Account
    • Patient Portal
    • Make a Payment
  • My Account
    • Patient Portal
    • Make a Payment
menu
PatientFirst
‌
  • Services
    • Urgent Care
    • Primary Care
    • X-rays
    • Lab Testing
    • Prescription Drugs
    • Immunizations
    • Occupational Health
    • Conditions Our Providers Care For
  • Locations
    • Locations near me
    • South Jersey Area
    • Eastern Pennsylvania Area
    • Central Pennsylvania Area
    • Baltimore and Surrounding Areas
    • Greater Washington, D.C., and Fredericksburg Areas
    • Richmond and Surrounding Areas
    • Hampton Roads/Tidewater Area
  • Find a Physician
  • Insurance & Self-Pay
    • Insurance
    • Maryland Insurance Participation
    • New Jersey Insurance Participation
    • Pennsylvania Insurance Participation
    • Virginia Insurance Participation
    • Self-Pay
    • Maryland Self-Pay
    • New Jersey Self-Pay
    • Pennsylvania Self-Pay
    • Virginia Self-Pay
  • For Employers
    • Overview
    • Health Services
    • Forms & Resources
    • DOT Physicals
    • DOT Examiners' Schedules
‌

Forms

Authorization for Release of Information

English

Authorization for Release of Information
PDF

Español

Authorizacion de Entrega de Informacion
PDF

Treatment and Payment Policy

English

Maryland Treatment and Payment Policy Form
PDF
New Jersey Treatment and Payment Policy Form
PDF
Pennsylvania Treatment and Payment Policy Form
PDF
Virginia Treatment and Payment Policy Form
PDF

Español

Politicas Sobre Tratamientos y Pagos Para Maryland
PDF
Politicas Sobre Tratamientos y Pagos Para New Jersey
PDF
Politicas Sobre Tratamientos y Pagos Para Pennsylvania
PDF
Politicas Sobre Tratamientos y Pagos Para Virginia
PDF

Contact Us

Question or Comment about a Visit Form
WEB
General Feedback Form
WEB
Itemized Statement Request Form
WEB
Center Contact Information
PDF

For Employers

Worker's Compensation Re-file Form
WEB
  • FAQ
  • Forms
  • Healthcare Links



Connect with Us

Facebook Twitter Instagram Pinterest LinkedIn

5000 Cox Road
Richmond, VA 23060

Richmond 804-968-5700
Toll Free 800-447-8588
Fax 804-968-5725

Contact Us
  • Patient Portal
  • About Us
  • Make a Payment
  • Careers
  • Your Privacy
  • Contact Us
  • FAQ & Resources
  • Notice of Nondiscrimination
Accredited Urgent Care Center
Urgent Care Association of America

©2019 PatientFirst. All Rights Reserved. Terms Of Use Privacy Statement Employee Login