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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.

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

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  • 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. 48-hour notice is required for cancellation or rescheduling of appointments to avoid 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

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Tuesday: 9AM – 5PM

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Wednesday: 9AM – 5PM

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Thursday: 9AM – 5PM

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Friday: 9AM – 1PM

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© 2021 by Polaris Heart & Vascular Clinic

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