Patient Forms

Please print and fill out these forms prior to your visit.

Click below to download the forms in Acrobat Reader:

Consent for Release of Protected Health Information Form (new patients or if you have been to any other providers)

Registration Information Form (new patients)

Medicare Secondary Payer (MSP) Form (Medicare patients)

Health History Forms (2 Pages) (New patients, Physicals, Yearly)

M-CHAT Form – Ages 18 and 24 Months

Pediatric Symptom Checklist (PSC) Form, Ages 6-10 years

Pediatric Symptom Checklist – Youth Report (Y-PSC) Form, Ages 11-17 years

Vance Family Medicine

4.7

Based on 464 reviews

review us on

cassandra Ramey

06:31 17 Jan 23

I am very satisfied with the medical support at Vance Family Medicine and I recommend everyone to use the service to stay in good health. The staff members work collaborative to ensure the patients receive the best care on their visit and follow up with lab work.If you want to know what is going on inside of the company, you should look at the top leadership. That is, Vance Family Medicine provides excellent heathy tips of wellness for any medical concern and for all family members .The clinic accept walk-ins Sunday through Saturday , seven days a week, as well as, you can make appointments with specific physicians. For example, I appreciate Dr. Vu medical support in my life . His medical advise has improved my health over the years.Happy News to the Reviews

Dale Hughes

11:50 23 Dec 22

Nothing but positive things to say about the staff and providers at Vance Family Medicine. My family and I have been seen here for years. I have been a patient for almost 11 years. I’ve never had a negative experience with the staff or providers at VFM. They are exactly what our community needs and I am so thankful for their ability to be open on weekends and off hours, which seems to be exactly when sickness hits families with small children. Thank you again VFM!

Caitlin Pernell

15:02 21 Nov 22

I think that Vance Family Medicine is one of the best Medical Practices in the area. The providers at Vance Family Medicine are very knowledgeable, patient, and always so caring. My family & I have been patients here for over 20 years. We have seen many of the different providers and they all have been wonderful! It is easy to call and make an appointment with a provider of choice, and they also take walk ins. Their open hours are also impressive with staying open longer in the evening, weekends and some holidays. It’s true that no one really likes to have to go to see a doctor, but it is nice to know that when you are the patient and seen at Vance Family Medicine you will be well taken care of!

Stacey Garner

15:09 28 Oct 22

I am so thankful for the excellent team of Providers at Vance Family (Doctors/ PA's/Nurses). I appreciate the kind and healing way they take care of me and my family. They are open 7 days a week and this helps me and my family very much to have access to care when needed.

Diamond Anderson

18:04 27 Oct 22

I love how community driven Vance Family Medicine is. Kuddos goes out to the staff, especially during the outbreak of the Covid-19 pandemic. All of the staff are especially nice. The young lady Ms. Dominique that handles prior authorizations is always so professional and she has a lot of knowledge in her area of work.

With the NEW school year fast approaching, please make sure your child is up to date with all their vaccinations!

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