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Neurology Center of Fairfax

703-876-0800
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Packet: New Patient for Sleep Consult

Instructions:

Please fill out the following 9 forms prior to your appointment. Documents not submitted 7 days in advance of your appointment may not be available to your doctor at the time of your appointment. Thank you.

Patient Authorizations
Authorization to Access PHI
New Patient Form
Medication List
Review of Systems & History
Sleep Health Questionnaire
NCF Feelings Survey
Fatigue Severity Scale (FSS)
Fatigue Scale
Modified Fatigue Impact Scale (MFIS)

If we do not have a copy of your most recent government ID or insurance card/s, please upload them here.

File Upload Form

For Your Information

Information for our patients (PDF)
Notice of Privacy Practices (PDF)

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Locations

Fairfax Office
3020 Hamaker Ct, Suite 400
Fairfax, VA 22031

703-876-0800 | Fax: 703-876-0866
Reston Office
1830 Town Center Drive, Suite 305
Reston, VA 20190

703-876-0800 | Fax: 703-876-0866
Sleep Diagnostic and Treatment Center
3020 Hamaker Ct, Suite 400
Fairfax, VA 22031

703-876-2850 | Fax: 571-308-1158
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