Schedule an Appointment Online or call us at (540) 450-3339

We welcome you as a patient and appreciate the opportunity to provide for your health care needs. It is the goal of our entire staff to provide the finest in comprehensive primary health care. We want you to know about our policies and methods of practice. The more you know, the better we can be of service. Your questions are always welcomed and encouraged.


Medical Release Form I (from WFP to another practice) - click here to download
This form is to be completed to have your medical release from Winchester Family Practice.  For example if you require your records to be faxed  to a specialist for an appointment, if you just  want a copy for your files, or if Mom or Dad need a copy of an immunization for school.  Make sure you sign for yourself or as the guardian or parent and return the form to us.

Medical Release Form II (from another practice to WFP) - click here to download
This form is to release medical records from another doctor to Winchester Family Practice.  If you are transferring your care here to us as your PCP, and you have already scheduled your appointment, we would appreciate receiving this form so we may obtain your prior medical records before your appointment with us.

New Patient Forms - click here to download
These are Winchester Family Practice's New Patient or HIPAA forms.   The first page is asking for your information, and the information of  the person that carries your insurance if it is not yourself.  The second page is asking for your signatures to bill your insurance, to share information with your insurance so that they may pay us and at the bottom you will see our office policies.    The third page is where you will list any names of people that may call in to discuss your health, medication, treatment or appointments with us.   If you do not list a spouse, they cannot not call us to schedule an appointment or refill a medication!   We also ask that you bring their insurance card(s) and any co-pay you may have for an office visit and arrive 15 minutes early to give us time to get you registered.

Influenza Forms - click here to download
This is the Centers for Disease information forms that we hand out when patients are given their flu vaccines. Upon download you will see two 2-page forms. The first form is for the regular flu vaccine for ages 6 months of age and older.   The second form is for the "Flu Mist",  It is a live vaccine that is sprayed into the nostrils, and is only recommended for people age 2 through 49 years of age.

It is recommended that everyone should receive the influenza vaccine. The "flu" is contagious and can be spread by a runny nose, sneezing, or coughing.   Always remember to wash your hands, and sneeze or cough into your elbow or tissue.  Teach your children to protect themselves,  little ones are more prone to "share" their germs unknowingly. Symptoms may include: Fever/chills, Sore Throat, Muscle Aches, Fatigue, Cough, Headache, Runny or Stuffy Nose.

The CDC states that the influenza viruses are always changing, so annual vaccination is recommended.  It takes up to 2 weeks for protection to develop after the injection/intranasal and this protection will last about a year.

Poison Center - click here for download

Shelter for Abuse - click here to download

LIS:  Assistance for Medicare Part D Patients - click here to download  for more information!
LIS (or Extra Help) is financial assistance for Medicare Part D Patients with low income nad limited resources.

Depending on their financial need, LIS patints can receive either full or partial LIS benefits.  LIS patients do NOT have an:   1) annual or monthly premeium,   2) annual deductible,  3)  coverage gap or "donut hole",  or 4) a co-pay if they reside in a nursing home. 

If you are on Medicare or Medicare and a secondary insurance please apply for your Extra Help by:

  • Applying online at
  • Call Social Security at 1-800-772-1213 to apply or request a paper application
  • Visit your local Social Security office to apply


Prescription Refills: Chronic Medications can be refilled during office visits or by having your pharmacy fax us a refill request.  Please allow 5 to 7 days for all routine prescription refills.  For antibiotic prescriptions, it is in your best interest to be seen in the office first.

Payments / Insurance: We participate with most insurances.  Please bring your insurance card to the office visit with you.  Your are responsible for all co-pays, deductibles, and any  non-covered  expenses at the time of your visit.

Appointments: Please call to schedule all appointments.  Urgent problems can be worked in on the same day.  Please call us 24 hours in advance if you need to cancel an appointment.  There is a fee for all missed appointments if you do not show or cancel them.

Lab Results: Allow up to 2 weeks for us to notify you about non-urgent labs or test results.  Please check your Dialtell message retrieval system before contacting the office.

© 2012 Winchester Family Practice. All rights reserved 1440 Amherst St Winchester, VA 22601 (540)450-3339