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Patient information form
 

Below you will find our patient information form. You can save time by completing this form prior to your visit. If possible, please print, fill out and fax the form at the number given below, prior to your visit. Or, bring the completed form with you at the time of your visit.

Fax number: 540-338-0176

Click here to download patient information form.

Participating insurances

Payment Policy:


VMC Urgent Care participates with most major insurance carriers. Participating insurance companies may be billed directly for services covered by your plan if we are provided with the insurance information at the time services are rendered. For your convenience, VISA, MasterCard, Debit Card, personal check, and cash are accepted.

Participating Insurance Providers:
  • Aetna / US Healthcare HMO and PPO
  • Alliance PPO
  • Blue Cross / Blue Shield of Virginia (Trigon / Anthem)
  • Champus (Tricare)
  • Cigna PPO
  • Corvel (w/c insurance)
  • First Health (formerly Affordable)
  • Healthkeepers
  • MAMSI
  • MDIPA HMO
  • MDIPA Preferred
  • Medallion
  • Medicaid of Virginia
  • Medicare
  • Multi Plan PPO
  • National Providers Network (NPN)
  • NCPPO
  • One Health
  • Optimum Choice HMO
  • Optimum Choice Preferred
  • PHCS
  • Southern Health (Qualchoice)
  • Trigon Blue Cross / Blue Shield of Virginia PPO (Anthem)
  • Unicare Medallion II
  • United Healthcare
  • United Payors and United Providers (UP & UP)
  • VA Health Network
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Virginia Medical Center & Urgent Care.
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