PATIENT FORMS

NEW PATIENT FORM

MEDICATION LIST

HIPAA NOTICE OF PRIVACY PRACTICES

  • 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

  • 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

  • RESCHEDULE OR CANCEL 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.

Visit Us
Contact Us

Phone: (571) 398-2341

Fax: (571) 398-6388

Address: 2022 Opitz Blvd Suite A & B, Woodbridge, VA 22191

Hours

Monday: 9AM – 5PM

Tuesday: 9AM – 5PM

Wednesday: 9AM – 5PM

Thursday: 9AM – 5PM

Friday: 9AM – 6PM

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© 2021 by Polaris Heart & Vascular Clinic

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