New Patients

For new patients, please download, print, complete the following forms and bring them to your first appointment to save yourself time! You do not need to print or bring the HIPAA disclosure but please review this important document.

HIPAA Disclosure Form
HIPAA Acknowledgement of Receipt Form
OB/GYN History
Patient Information Form
Authorization for Release of Medical Information (Only needed for transfer of records)

Office Policies

At Loudoun Community Midwives we try very hard to keep our office schedule running “on time” and to provide excellent services to all our patients. We ask your understanding and cooperation with these policies:

• Late Arrivals: If a patient arrives more than 15 minutes late for a scheduled appointment, we may need to re-schedule for a different day, rather than disrupt the rest of the day’s appointments.
• "No-Show”: If a patient has made an appointment and we made a confirmation or reminder call, a charge may be assessed if the patient does not keep the appointment.
• Lab Work Policy:  We do offer the convenience of drawing blood in the office for our pregnant patients.  Lab results will be reported to patients by phone only if they have abnormal results which require some intervention, such as a prescription or a re-test.  Normal results will be reported at the next routine office visit.
• Prescription refills:  A refill of an LCM-written prescription can be done through a request to your pharmacy.  The pharmacy will fax us (@ 703-726-9612) a request for refill, and we will refill it by fax, when appropriate.  No need to call the office!