Office Hours:
Monday: 9:00 a.m. - 3:30p.m.
Tuesday: 8:30 a.m. - 4:30 p.m.
Wednesday: 9:00 a.m. - 4:30 p.m.
Thursday: 9:00 a.m. - 3:30 p.m.
Friday: 9:00 a.m. - 3:30 p.m.
Phone: 804.320.4967 | Fax: 804.320.7130

OBSTETRICS • GYNECOLOGY • FAMILY PRACTICE
Patient Forms
  • Patient Registration
    PDF doc to print or complete electronically
  • Notice of Privacy Practices

              PDF doc

  • Release of Information Authorization from the office of CCCW (to authorize another provider to obtain your records from CCCW)
    PDF doc to print or complete electronically
  • Release of Information Authorization to the office of CCCW (to authorize CCCW to obtain your records)
    PDF doc to print or complete electronically

 
COMPLETE CARE FOR WOMEN
c/o Dr. Sumac Diaz and Dr. J.M. Carpenter
7107 Jahnke Road | Richmond, VA 23225
Phone: 804.320.4967 | Fax: 804.320.7130
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