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2018 Exchange Update


Below are the most common forms that a patient might need.  If you have any questions on which forms might pertain to your visit, please call us at 703-266-2442 and we will be happy to assist you.

Demographics Form

HIPAA Consent Form

Financial Responsibility

Patient Medical History

Medicare Wellness Form (also need Patient Medical History)

Understanding Your Visit Acknowledgement

Self Pay Policy

Authorization to Release Medical Information to a Third Party

 

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