Dr. William Earl Fox
General Adult Psychiatry  |  434-244-3771
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Online Patient Registration Forms

​Please fill out and submit all patient registration forms at least 2 days prior to your initial evaluation. These forms can be completed online.
Patient Registration Form
Patient Consent Form
Patient Authorization Form

Downloadable Forms

The following forms are provided for your convenience. Please click on a form below to download the PDF file to complete or print a copy.
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  • Patient Registration Form
  • Release of Medical Information Form
  • HIPAA Form
  • Privacy Practices Awareness Form
  • Schedule of Fees
  • Credit Card on File Authorization Form

Have a Question?

Contact the office manager, Rikki, by calling 434-244-3771 or send an email.

Areas of Practice

  • Anxiety Issues
  • Mood Issues
  • Difficult Relationship Issues
  • Significant Life Transitions
  • Life Direction, Values, and Meaning
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