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(703) 443-2000
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Become a Patient

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.

Interpretation: Certified Medical Interpreters are available in different languages.

Interpretation: Certified Medical Interpreters are available in different languages.

General Document & Form Downloads

  • English

  • Spanish

  • New Patient Welcome Letter
  • Patient Check List
  • Patient Registration Form
  • Medical History Form
  • Notice of Privacy Practices
  • Acknowledgement of Receipt of Notice of Privacy Practices
  • Authorization for Release of Protected Health Information
  • New Patient Welcome Letter
  • Patient Check List
  • Patient Registration Form
  • Medical History Form
  • Notice of Privacy Practices
  • Acknowledgement of Receipt of Notice of Privacy Practices
  • Authorization for Release of Protected Health Information

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.

Sliding Discount Fee Document & Form Downloads

  • English

  • Spanish

  • 2024 Poverty Guidelines and Slide Discounts
  • Sliding Fee Discount Application
  • Self Declaration of Income
  • Employment Verification Form
  • 2024 Poverty Guidelines and Slide Discounts
  • Sliding Fee Discount Application
  • Self Declaration of Income
  • Employment Verification Form

For Patients

  • Become a Patient
  • COVID-19 Updates
  • Request an Appointment
  • Sliding Fee Discount Program
  • Telehealth
  • Patient Portal
  • Online Bill Pay
  • FAQs

Do you have questions about HealthWorks or our services?

Contact Us

Leesburg

163 Fort Evans Road NE
Leesburg, VA 20176
More Location Information
Fax Number
703-443-2033

Dental Suite 1st Floor.

Herndon

1141 Elden Street, Third Floor
Herndon, VA 20170
More Location Information
Fax Number
703-435-6752

Dental Suite 218

Reston

11484 Washington Plaza West
Reston, VA 20190
More Location Information
Fax Number
703-657-2142

Sully (Herndon)

13800 Wall Road, Suite 055
Herndon, VA 20171
Fax Number
571-306- 7741

Sterling

21641 Ridgetop Circle, #107
Sterling, VA 20166
Fax Number
703-443-2033

For non-emergencies, current patients can reach our after-hours service by calling: 703-443-2000.

HealthWorks for Northern Virginia health centers are Federal Torts Claims Act (FTCA) deemed facilities. HealthWorks is a 501(c(3) nonprofit community-based Federally Qualified Health Center (FQHC). HealthWorks is a Health Center program grantee under 42 U.S.C. 254b, and deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

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