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.
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)