Patient Forms & Information

Below are some of the forms we use in our office for new and existing patients. We supply each as reference so that patients may be prepared for their appointment when they visit our office. If you so choose, you mayprint and complete the forms in advance to help expedite your appointment time.

You can Fax them in advance to 703-689-0859.

		New Patient Health History Form		A complete profile of your medical and dental health history so we are prepared to give you the best and most effective treatment possible.
		New Patient Registration Form		Basic registration form for new patients.
		Sedation Instructions & Consent Form		A breakdown of the instructions for before and after IV sedation is used for your appointment.
		Understanding Insurance		An overview of what insurance means to your dental care.
		Financial Options		An overview of your financial options for care in our practice.
		Patient Release		Patient Authorization to Release Records to Dr. Charles Fields.