Medical Center of Stafford Patient Forms

For your convenience we have posted the following forms. These files require the Adobe Acrobat Reader.

Patient Registration Form
Privacy Disclosure Form
Guarranty of Payment Form
Policies and Procedures Agreement
Notice of Privacy Practices
Authorization to Release Medical Records Information Form

If you have any questions, please feel free to call us at 540.659.4157 or ask us when you come in for your appointment.

Patient and Department Information: 540.741.1100 or 540.741.9000 | 24-hour Nurse Line: 540.741.1000 | General Inquiries: 540.741.1404
Mary Washington Healthcare, 2300 Fall Hill Avenue, Fredericksburg, VA 22401
Mary Washington Hospital, 1001 Sam Perry Blvd., Fredericksburg, VA 22401 | Stafford Hospital, 101 Hospital Center Blvd., Stafford, VA 22554