Patient resources

Patient forms

Forms can be completed online through the patient portal or printed and brought with you to your appointment.

Common Privia forms for registration, treatment consent, preferred contacts, virtual visits, and health information exchange.

Authorizes disclosure of health information to a designated individual, company, agency, or facility.

Covers consent for treatment, communications, assignment of benefits, and financial responsibility.

Lets patients share preferred contact details for communication with the care center.

Describes documentation, maintenance, and transmission of information for virtual visit technology.

Allows patients to opt out of sharing protected health information through health information exchange networks.

Office policies

Policies and notices that explain financial responsibility, privacy practices, and patient protections.

Explains patient financial responsibility for services received without regard to insurance eligibility or coverage determinations.

Describes how health information may be used and disclosed and how patients can access individually identifiable health information.

Explains Privia Medical Group nondiscrimination and accessibility requirements.

Explains free language assistance services for patients whose primary language is not English.

Privia's patient resource for surprise billing protections and good-faith estimate information.