Skip to main content
Home

Search Inova

Utility Top Menu

  • ER wait times
  • Careers
  • Bill pay
  • MyChart Login

Primary navigation

  • Get care
  • Find a doctor
  • Services
  • Locations
  • Patients & visitors
  • Give
    • Donate to Inova
    • Donate time
    • Donate blood
    • Donate life
In this section
  • Locations
  • Walk-In Services
  • Patient Forms
  • Virtual Visits
  • Prevention

Breadcrumb

  1. Go to homepage
  2. Our Services
  3. Inova Primary Care
  4. Patient Forms

Inova Primary Care Patient Forms

Convenient. Personal. Comprehensive Care.
Find a Doctor Book an Appointment MyChart Login
Inova Primary Care
Find a Doctor Book an Appointment MyChart Login
Inova Primary Care
Patient fill out forms

Patient Forms

If you are a new patient seeing an Inova primary care or specialty doctor, you may be asked to complete the forms below and bring them with you to your appointment.

There may be additional forms your specific physician needs you to complete once you arrive at the office. Please arrive 15-20 minutes before your appointment to complete any other needed paperwork. Also remember to bring your insurance card and photo ID to each visit, as well as a list of your medications (prescription and over-the-counter).

Forms for all patients

  • Inova Physician Services patient registration form
  • Authorization for claims payment and reviews
  • Notice of privacy practices
  • Acknowledgment of receipt of notice of privacy practices
  • ADA special needs assessment
  • Patient Record of Disclosure: Preferred Contacts
  • Patient Rights and Responsibilities
  • Notice of Non-Discrimination
  • Advance Care Planning: Planning for Future Healthcare Decisions

Medical Release Forms

  • Release of medical information form
    (To ask Inova to release your medical records to another doctor's office)
  • Standard medical record release
    (To ask another doctor's office to release your records to Inova)

Primary Care Patients – Medical History Form

This form should be completed by all new patients who are seeing an Inova Primary Care provider.

  • Medical Condition and History Form

Specialty Care

Our specialty care offices will often have additional forms specific to their practice that they will ask you to complete. Please refer to the online content for your specialty physician's practice to see if other forms may also be requested.

Inova wants you to be aware of your rights, and responsibilities, as a patient. We believe your patient rights are important, and we will do everything possible to make sure that your rights are respected.

Download our patient rights and responsibilities information:

  • English
  • Amharic
  • Arabic
  • Farsi
  • Korean
  • Mandarin Chinese
  • Spanish
  • Urdu
  • Vietnamese
Home
8095 Innovation Park Drive
Fairfax, VA 22031
8095 Innovation Park Drive,
Fairfax, VA 22031
Questions? Call 855-694-6682

Footer

  • Patient resources
    • MyChart login
    • About MyChart
    • Medical records request
    • Medical image request
    • Patient education
    • Find a doctor
    • Find a service
    • Find a primary care provider
    • Classes and events
    • Patient forms
    • Clinical trials
    • Billing information
    • Health library
    • Subscribe to newsletter
  • Locations & facilities
    • Inova Alexandria Hospital
    • Inova L.J. Murphy Children's Hospital
    • Inova Fairfax Hospital
    • Inova Fair Oaks Hospital
    • Inova Loudoun Hospital
    • Inova Mount Vernon Hospital
    • Inova Women's Hospital
    • Inova Blood Donor Services
    • Inova Center for Personalized Health
    • Inova Emergency Services
    • Inova Primary Care Offices
    • Inova Schar Cancer
    • Inova Schar Heart and Vascular
    • Inova-GoHealth Urgent Care
    • Inova Eastern Region Development Plan
  • Healthcare professionals
    • For Physicians and APPs
    • For nurses
    • Education and CME
    • Research
    • Inova careers
    • Physician job opportunities
    • Signature Partners
  • Company information
    • About Inova
    • Inova careers
    • Inova Foundation
    • Inova in your community
    • Inova Newsroom
    • Price transparency
    • Inova Well
    • Volunteer opportunities
    • For employees
Official health system for
Washington National logo
Nationals
Washington Spirit logo
Spirit
D.C. United logo
United

Legal & Policy Menu

  • Web policies
  • Nondiscrimination policy
  • Privacy and compliance
  • Preference Center
© 2025 Inova

Social Media