Forms & Policies

The following documents may be printed out and returned to our office via mail or fax to (703) 370-2843. Medical release forms for transfer patients must be sent or faxed to the patient's previous practice. Additional documents are for informational purposes only.

Administrative

New Patient and Annual History Form

• Privacy Acknowledgement
• Patient Record of Disclosures
• Insurance Disclaimer
• History Questionnaire
• Cancellation Policy/No Show Policy for Doctor Appointments
• Authorization for Disclosure of Protected Health Information
• Authorization for Release of Medical Records

Health

• Management of PMS
• Iron Supplements

PROCEDURE INSTRUCTIONS

• Hysteroscopy and/or D&C
• Laparoscopy
• Laparotomy
• LEEP Instructions

Pregnancy and Postpartum

• Pregnancy Instructions
• Post Partum Information
• Labor Instructions
• Prenatal Genetic Screen

All forms are in Adobe PDF format. If your system is having trouble opening PDF documents, a free viewer can be downloaded from the Adobe website.