Releases & Forms

Releases

• Authorization for Release of Medical Information
• Authorization for Release of Pathology Slides

Forms

• Download Infertility Coverage Waiver Form
• Download Social Media Consent Form
• Transvaginal Mesh Informed Consent Form
• Self Pay Surgery Policy
• Recurring Credit Card Payment Authorization

Notice

Surgeons may have an investment interest in Reston Surgery Center and Loudoun Ambulatory Surgery Center. Patients may choose any hospital or surgery facility (subject to the surgeon having appropriate medical staff privileges at such hospital or surgery facility).