Patient Portal

Patient Forms


As our medical practice moves towards implementing an Electronic Health Record (EHR) system, in addition to our forms being accessible below, they can now also be found on our Patient Portal.

To access the forms on our Patient Portal, you will need to create a user account. If you do not have a PIN number to set up your user account, please contact our appointments line at 703-876-0800, option #3, or click on the "Register" link at the top of the Patient Portal web page and follow the instructions. Click the link below to visit our Patient Portal.


Patient Portal

Notice of Privacy Practices

New Patient Forms

Follow-up Patient Forms

Epworth Sleepiness Scale

Request Medical Records

Disability Forms

Medical Appeal Guidance


Disclaimer

The information provided by neurologycenteroffairfax.com is for informational purposes only. Do not rely on neurologycenteroffairfax.com or any site accessed through neurologycenteroffairfax.com for medical advice. The content on this site is not intended to be a substitute for professional medical advice, treatment, or diagnosis. Always consult your physician or other health care provider for any questions you may have regarding a medical condition, diagnosis, or treatment. If you have questions about your health, you should consult your personal physician. If you think you have a medical emergency, dial 911 immediately.