Patients Forms

Thank you for choosing Vascular Associates of Northern Virginia for your vascular health needs.  Below you will find all the necessary forms you need for registration.  Please take a moment to fill them out and print before you come in to your next appointment.  All forms are in a PDF format.  For your convenience, all forms can be filled electronically before printing and signing.


To schedule your appointment, please call us during office hours (9:00 am to 5:00 pm, Monday through Friday) at (571) 375-7174.  Please visit our “Contact Us” page for our complete contact information and directions.

We look forward to serving all your vascular health needs.

If you are doing a Telemedicine Visit

Please fill out the forms, save them to your desktop and email them to us at

Please keep in mind that communications via email over the internet may not be secure or comply with HIPAA. Although it is unlikely, there is a possibility that information you include in an email can be intercepted and read by other parties besides the person to whom it is addressed.

If you prefer, you may fax your paperwork to us at 571-375-7177