Patient Forms

Here you can find forms for patient eligibility, intake forms, and all other necessary documentation. Here is a list of available forms you can download and print.

Click the buttons to download printable forms.

Medical Records Request

Uninsured Applicant Portal

Medical Annual Wellness Assessment

New Patient Forms

School Forms

Don’t see a form you need? Let us know by calling our office at 540-785-8500.

"I was really sick and didn't have insurance. FCHC took me in and treated me like family. They not only cared for my physical health but also prayed with me and supported me emotionally. I'm forever grateful."
- Patient