2015 FPSR STAFF 090


Collecting all of the required information from patients needed to bill insurance companies is a necessary burden, therefore, we have eliminated written forms!  Patients are handed a touch-screen computer tablet upon arrival and the registration process is done electronically. If any questions or assistance is required, our wonderful front office staff will be available during this time.

For your convenience, you may download and read our Financial Policy, Notice of Privacy Practices, Medical (HIPAA) Disclosure Form, Patient Portal Agreement, and our Patient Registration forms below.

FPSR Financial Policy

Notice of Privacy Policy

Disclosures to Family Members and Friends

FPSR Patient Registration Form

Patient Portal Consent Form

For our Cosmetic Patients having a first time skincare treatment, please download and complete our skin assessment form.  

Skin Assessment Form

Company Directory

Main Office to Schedule Medical Appointments804-330-3335
Skin Care Department and/or Concierge Practice Inquiries804-423-1514
Referral Coordinator for Drs. Siedlecki, Miller, Turner, Laura Eastman FNP, Brenda Canada FNP and Rx Prior Authorizations804-423-1515
To Schedule Dietitian Appointments or In-house Colonoscopy/EGD804-423-1515
Referral Coordinator for Marianne Hagood FNP, Dalia Elsayed FNP804-330-5987
Billing Department804-330-5984
Fax Number804-320-2717
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