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Patient Forms

 

Our friendly and competent staff is dedicated to your comfort and quality of care throughout your visits. We provide the best and latest in medical technology and treatment options. We emphasize maintaining existing healthy habits while improving where medical attention is needed. Our team emphasizes comprehensive quality care and progressive medical treatments.

 

Please complete and print all four forms before your first appointment.

Also, please bring your insurance card, Photo id and all medicine to every visit.

 

Fillable Pdf Forms

 

New Patient Registration Form 

 

Health Questionnaire Form

 

Office Policy Form

 

Release of Medical Record

 

 HIPAA Policy

There will be a $25 dollar charge for any missed appointments or if you reschedule within 24 hours of your scheduled appointment time.

Call : 703-820-7000

Beauregard Medical Center

4660 Kenmore Avenue,Ste 900

Alexandria, VA 22304

Fax : 703-931-0059

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                  WORKING HOURS

 Monday -  Friday   7:00 am - 5:00 pm

                 Saturday  8:00 am - 1:00 pm
Sunday  Closed

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