2809 North Avenue Richmond, VA 23222
1-804-780-0840

Patient Forms

Welcome to your New Medical and Dental Home!

Capital Area Health Network is committed to meet the growing needs of our current and future patients and increase our capacity to provide primary and specialty care services, patient education, and advocacy. Our ultimate goal is to eliminate health disparities, respond to diverse community needs, and improve the quality of life for all individuals, including the medically underserved and those experiencing barriers to care.

As a patient of CAHN’s, we treat you like family. We ensure accessibility at all times by providing you with a way to communicate to your doctor 24 hours every day through our Patient Portal.

We serve as a reliable access point for connecting residents to health and human support services to further meet our pledge and privilege to serve each individual who enters our doors. Thank you for trusting us with your health.

Please take a few minutes to print and complete the Patient Registration Form to minimize your wait time in our office. If you are a parent of a minor, please also complete the Parental/Legal Guardian Authorization to Treat a Minor. If you are uninsured or need financial assistance with your visit, please complete the Sliding Fee Scale Eligibility Documentation Form. Please complete all the necessary forms and bring them to your appointment along with your photo IDSocial Security Cardcurrent insurance cardproof of income (if uninsured) and a list of all the medications you are currently taking. Thank you for making us your Medical Home! We look forward to providing you with quality care.

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