New Patient Forms
and Instructions

Prior to your exam, you will complete a health history which helps us identify oral and overall health issues we should watch out for. The form is available on this page. While you may be surprised at the thoroughness of the form, we believe it is important we have all relevant information as part of healthcare team, and it is an important step in helping us care for you properly.

What you should bring to your first visit:

1. Dental insurance card, if applicable
2. Photo ID card
3. Completed new patient forms

The forms are PDFs and require you have Adobe Reader to open them. Nearly all computers have this. If you cannot open the form, you can download it here: 
Adobe Reader

We’ll need the information on the form prior to getting started. Please download and complete the form below and bring it to your first visit. If you are not able to complete these forms prior to your first visit, please arrive 30 minutes before your scheduled appointment.

New Patient Form

(PDF)
Click To Download ›

YOUR NEW SMILE STARTS WITH A PHONE CALL

Schedule Your Appointment

Click To Schedule ›
OFFICE LOCATION
9004 Crownwood Ct., Suite A
Burke, Virginia 22015
OFFICE HOURS
Monday: 9:00 a.m. to 3:00 p.m.
Tuesday: 7:00 a.m. to 4:00 p.m.
Wednesday: 7:00 a.m. to 4:00 p.m.
Thursday: 7:00 a.m. to 4:00 p.m.
Friday: Closed
Saturday: Closed
Sunday: Closed
Schedule Your Appointment ›Talk to a Treatment Coordinator: 703-569-4040 
Northern VirginiaNova
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