Doctor Appointment Forms

Dr. Tansey and Dr. Cartaya have opt-out status with Medicare. In addition to the registration and agreement forms above, federal law requires their Medicare-enrolled patients to complete and sign a private contract before any health care is initiated.

Medicare Agreement Form

If you are requesting other care providers send information for our doctors to review prior to your appointment or during your care, our consent form may be completed and sent to the provider to facilitate record requests. As many of our clients are working with providers at the University of Iowa Hospitals and Clinics, we have provided their specific directions for your convenience.

Consent to Obtain Information

Obtain UIHC Medical Records

If you are requesting that the Virtue Medicine doctors/coaches provide your confidential records or information from our office, please click on the link below and complete the form for every person/office whom you would like to receive your information. Bring the signed forms to your next appointment, or mail them to our office, specifying all details that will help us accurately fulfill your request.

Consent to Release Information