Downloadable Patient Forms

If you are a new patient to Olde Towne Medical and Dental Center, you may download the appropriate form, complete, and bring with you to register for your first appointment.

Patient registration forms must be updated yearly.

SAVE TIME!

Download and fill out your forms now and 

email to OTMCinfo@jamescitycountyva.gov

or fax to 757.220.1953

prior to your appointment

Patient Registration (English)

Patient Health Information Release (English)

Patient Registration (Spanish)

Patient Health Information Release (Spanish)

Patient Registration (French)

Patient Health Information Release (French)

Financial Support Letter (English)