Patient Information and Pre-Visit Checklist

Dear Patient, we have provided the forms below to assist you with your visit to our practice. This enables us to provide you with a speedy check-in process. This can save you valuable time by completing the forms prior to your visit. If possible, please fill out, print and fax the forms [Patient registration form and HIPAA form] prior to your visit. Or, bring the completed form with you at the time of your visit. The Patient registration form has three pages. A copy of the HIPAA Privacy Notice can be found on our Home Page. Thanks.

Fax: 703-858-9442

PATIENT REGISTRATION FORM	HIPPA ACKNOWLEDGEMENT