New Patient Form

Medication List

What to Bring to Your First Office Visit

 

  • Insurance card(s)

  • Photo identification such as a driver's license

  • Referral form (for HMO insurance, if required)

  • List of current medications you are taking including prescriptions, over-the-counter medications, and any herbs

  • Copies of any and all recent laboratory results performed by your Primary Care Physician or referring specialist.

  • Relevant information about your medical and surgical history. Bring any pertinent x-rays or records you may have

  • Important questions you would like to ask the doctor

Schedule an Appointment

Please call (571) 398-2341, weekdays from:

  • 9 am - 5:00 pm

Voicemail prompts are available 24 hours a day, 7 days a week. A representative will return your call during office hours.

When calling, please be prepared to provide or confirm the following information:

  • Date of birth

  • Brief description of the reason for the appointment

  • Address

  • Home and alternate phone numbers

  • Health insurance information

  • Name of referring physician

  • Referring physician order/referral (have it with you) to ensure the scheduling of the appropriate appointment or test

Reschedule or Cancel an Appointment

 

Please call (571) 398-2341, to reschedule or cancel an appointment.

Your appointment time is reserved exclusively for you. Twenty-four hour notice is required for cancellation or rescheduling of appointments to avoid a $25 missed appointment fee.

HIPPA Notice of Privacy Practices

Polaris Heart and Vascular Clinic

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Monday -  Friday     9:00 am - 5:00 pm
Saturday                   Closed
Sunday                      Closed

Phone: (571) 398-2341
Fax: (571) 398-6388

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