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Loudoun Medical Group

Loudoun Medical Group

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Patient Forms & Info

To help save time during your visit, we have provided a copy of our LMG Patient Information Forms as well as the Privacy Forms to be downloaded and completed in the comfort of your home.

When you for your visit, please provide the front desk with your completed form. This will allow for the proper information to be reflected in your electronic record and support a quick check in process.

Forms

English:

LMG Patient Information
Notice of Privacy
Release of Medical Records

Spanish:

Información del paciente de LMG
Aviso de Privacidad
Autorización para divulgar información médica

Other Forms

LMG Referral Guide
Medicare Shared Savings Program - Accountable Care Organizations
Programa de Ahorros Compartidos de Medicare - Organizaciones Responsable de la Salud

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