Forms & Insurances


All patient forms are located inside our Patient Portal. We encourage you to log into the Patient Portal to complete all of our forms prior to your appointment.

If you are unable to create an account in the Patient Portal, you can expedite your first visit by printing the following forms, filling them out and bringing them with you to the office:

Please fill out one of the attached forms for us to release your records and send to the office:

Major Insurance Providers Accepted

Fairfax OB-GYN accepts most major insurance plans. Please call any of our offices to inquire about your particular insurance. We also accept self-pay patients and out of network patients and would be glad to assist you in arranging for payment of services. After services are provided, we will be glad to file claims to your insurance company on your behalf. We will assist you in making sure that your insurance pays us timely and appropriately for services we have provided to you. However, please know that ultimately you are financially responsible for payment of bills incurred. Any patient who schedules an appointment and fails to keep that appointment without providing 24 hour notice of cancellation will be responsible for a $50 no show fee. Any inquiries should be directed to the Billing Department at (703) 391-1500.

Anthem Blue Cross Blue Shield
Anthem Healthkeeper
Carefirst Bluechoice
United Healthcare
Our Locations

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