Become a Patient : HealthWorks for Northern Virginia

Become a Patient

Please call 703-443-2000 or email to schedule your first appointment at one of our three locations.
The Patient Registration Forms can be filled out and brought to your first appointment or completed 15 minutes prior to your first appointment with the help of our staff to answer any questions you may have.

To enroll as a patient, you will need to provide the following:
• Driver’s License, Passport or another form of ID with a photograph
• Insurance Card(s) [If you have insurance – this would include Medicaid, Medicare and TRICARE]

If you do not have any insurance, that is fine. HealthWorks offers a Sliding Fee Discount Program for enrolled patients who meet income requirements. To apply for our Sliding Fee Discount Program, proof of income is requested. Persons who have no income may also apply.

Medications: You should bring all the medications you are taking with you to your appointment. Bring the actual containers of the medications or a list of the medications, including the dosage and the number of times you take it per day. Include over-the-counter medications.

List of Concerns: Prior to your visit, write a list of the issues you would like to discuss with your health care provider.

Family/Friend: You are welcome to bring a family member or friend with you to the office.

Interpretation: Certified Medical Interpreters are available in different languages.

Forms To Download

Patient Checklist – English

Patient Checklist – Spanish

Patient Registration Form – English

Patient Registration Form – Spanish

Medical History Form – English

Medical History Form – Spanish

Notice of Privacy Practices – English

Notice of Privacy Practices – Spanish

Acknowledgement of HIPAA Receipt – English

Acknowledgement of HIPAA Receipt – Spanish

Authorization for Release of Protected Health Information – English and Spanish

New Patient Welcome Letter – English

New Patient Welcome Letter – Spanish

Sliding Fee Discount Program

Patients, including those with insurance, whose income is under 200% of the Federal Poverty Level, qualify for our Sliding Fee Discount Program. For patients who qualify, the office fee ranges from $35 to $65 dollars, plus additional lab fees if necessary. No patient will be denied care due to an inability to pay or because they do not have insurance.