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The materials posted on this website are for personal, non-commercial use only and may be downloaded only for personal use.
Republication, retransmission or reproduction of any images is strictly prohibited.
• Board Certified in Internal Medicine
• Board Certified in Gastroenterology and Liver Disease
• President of Medical Staff at Sentara Potomac Hospital
• Former Chairmen of Medicine at Potomac Hospital
• Assistant Clinical Professor of Medicine at George
Washington University & VCU
Forms
14904 Jefferson Davis Hwy. • Ste. 103 & 104 • Woodbridge, VA 22191
Patient Registration
& Health Questionaire
Health Questionaire
Welcome Letter
Authorization to Release
Medical Records
Printing and completing the medical release form found at the right of this web page may obtain medical records. Please complete all information and fax or mail to Dr. Razavi. All medical records are mailed to the home address we currently have on file. If records are obtained for personal use there is a nominal fee of $0.50 per page a for the first 50 pages then it is $0.25 cents per page after that., plus a $10.00 processing fee. This fee is to be paid prior to records being mailed or faxed. If they are faxed to the physician's office listed on the medical release form there is no charge. Please allow 10-14 business days for this to be processed.
Medication List
