Forms: Centerville Family Practice 

Appointment information

46A Broad Street Road, Manakin Sabot, VA 23103

​Phone number: 804-708-9480

  • Remember to bring your insurance card, photo ID, copayment and all medications. 
  • For children, we require immunization records prior to setting up the appointment.
  • We require compliance with CDC immunization guidelines for all new and existing patients.
  • If you are an adult that have not completed childhood immunizations please let us know. 
  •  Patients under 18 should come to appointments with parent, legal guardian or present a valid written note of authorization to come with a responsible adult.
  • Copay, deductible and coinsurance balances are due at the time of service. 
  • There is a charge of 5.00 per page for completion of forms (FMLA, pre-operative forms, pre-employment evaluation, foster care forms, school and college admission forms, sports physicals, etc.).
  • NEW: we have electronic form submission process to update your annual registration or change in insurance, this is availbale for new and established patients. We can activate your patient portal or via HIPAA compliant text link. 
  • We recommend that you arrive 15 minutes early to allow time to complete the intake paperwork if the electronic forms have not been submitted prior to your visit.
  • In order to serve our patients better, we have a no show/cancellation policy. If you can not make it to your appointment please call us 24 hours in advance to cancel your appointment. If you do not cancel 24 hours in advance you will be charged a no show fee of $25.
  • We are In Network with the following health insurances:
  • Commercial/Employer-sponsored plans from: Anthem Blue Cross and Blue Shield, Anthem Healthkeepers, Cigna (exclusions apply), Aetna, Optima, UnitedHealthcare.
  • Health Insurance purchased through the Marketplace: Anthem.
  • As of March 2019 we are not accepting any new Medicaid patients, we will continue to provide services to our established patients.
  • Traditional Medicare and supplemental plans.
  • Medicare Advantage Plans from Anthem Caremore, Aetna and  United Healthcare Plans PPO only.(Please make sure you have been assigned to our pannel prior to making the appointment)
  • Please review your plan coverage and deductible.
  • Please contact your insurance carrier to verify that we are in network providers and request a change in your primary care doctor information prior to your visit if necessary.
  • Centerville Family Practice is proud to provide quality healthcare to everyone. If you do not have Health Insurance we may be able to help, ask for details.
  • When scheduling your appointment, it is important to determine which type of visit you are requesting, so you get the right service and we are prepared to help you the best we can and we can dedicate the sufficient amount of time to over counseling and answering your health concerns.
  • Please see the infographic below for more information.
  • If you are scheduled for a preventive visit, but at the time of the visit you have a more pressing concern or an uncontrolled condition, the type of visit will change accordingly.