For your convenience and to offer you faster service, we are providing a Patient Information and Registration Form that you can download and print and complete prior to your visit.
REGISTRATION FORM
HIPAA CONSENT FORM
HIPAA PRIVACY NOTICE
HIPAA NEXT OF KIN FORM
FREQUENTLY ASKED QUESTIONS:
Q:What forms of insurance/payment do you accept?
A:Loudoun Walk In Medical Center accepts almost all major insurance plans. We make every effort to be a participating provider with as many insurance carriers as possible. Even when we are not contracted with your insurance carrier, we’ll still see you and provide you with the necessary paperwork to return to your insurance carrier for reimbursement. If you do not have insurance, we accept self-pay patients as well. We accept cash, personal checks, and all major credit cards. Payment of fees for services is due on the date that the service is provided.
Q:What do I need to prepare for my visit?
A: When you visit us, please bring one standard photo ID (driver’s license, state ID card or passport) and your insurance card with you. Please let us know if you have any allergies, if you are currently taking any medications (and the names of those medications) and your medical history. Please note that all persons under the age of 18 need to be accompanied by a legal guardian in order to be seen by the doctor.
