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Forms
14904 Jefferson Davis Hwy. • Ste. 103 & 104 • Woodbridge, VA 22191
Click on below forms for larger view and then print those forms, fill out, and bring to office at appointment time.
Patient Registration
& Health Questionaire
Health Questionaire
Welcome Letter
Authorization to Release
Medical Records
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.
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.
