Record Release Form
Existing Patients:
Please print the release form and either fax the completed form to 833-464-3281 or mail/dropoff to 1691 Innovation Drive Ste 2100, Blacksburg, VA 24060
Note: When filling out the form, please list "APCA" as who you "authorize and request."
New Patients:
Please complete the form with your child's pediatrician's name and have your pediatrician's office fax it to us at 540-408-0428