Download new patient online forms.
Complete your forms ahead of your visit. Print and bring them with you, or fax to (703) 698-5729.
Instructions
How to use our forms.
Download each required PDF, print it, and complete it before your first visit. You can also use Fill Out Online to send us your details so we can include the form in your packet.
Bring completed forms with you or fax them to (703) 698-5729. If you need Adobe Reader® to open a PDF, download it first.
Forms
All patient forms.
Notice of Privacy Practices (NPP)
Describes how medical information about you may be used and disclosed.
New Patient Office Policy
Patient information and initial history we need to know.
New Patient Welcome Form
Lets us know your health history, current state, questions, concerns, and wellness goals.
EHR Patient Health History
Demographics, contact preferences, and health history for your first visit.
HIPAA Consent of Treatment
Consent for treatment and use of protected health information.
Symptom Survey
A symptom checklist that helps your doctor see the full picture.
Accident / Injury Forms
Complete only if you are coming in after an auto accident or personal injury.
FAQ About Medicare
How Medicare applies to care at our office.
Thermography Centers Online Forms
Thermography intake is completed on the Thermography Centers site.
Need help?
Questions about your forms?
Our team is happy to help you complete your patient forms.
Start Your Journey toWellness.
Call, book online, or send a message, our Fairfax team replies within 24 hours.
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Rating
4.7★
110 Google Reviews
Hours of Operation
Open Today