Patient Information | Oral Surgery of NoVA

Download Forms:

Download the forms please print and complete them prior to coming to the office:

Patient Information Form ~ (click to download form)

Initial Consultation

Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. A complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day.

Please assist us by providing the following information at the time of your consultation:

Your surgical referral slip and any x-rays if applicable.
A list of medications you are presently taking.
If you have medical or dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.
Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are currently taking any medication (i.e., heart medications, aspirin, anticoagulant therapy, etc.).

Important Information:

Please note, a biological parent or legal guardian must accompany patients under the age of 18 years old. Failure to do so will result in your appointment being rescheduled. If there are concerns regarding treatment planning, we encourage both parents to be present at the initial appointment.

Affordable Care:

We offer a full range of budget plans to make quality care affordable.

Referral Forms:

Please feel free to download our referral form. The Referral Form may be faxed to our office or it may be brought during the consultation appointment. Please fax your Referral Form to the appropriate office location.

Note: referral form