(703) 472-3886
5901 Kingstowne Village Parkway, Suite 205,
Alexandria, VA 22315-5882
Examples
In Law Enforcement Officers
In Fire Fighters/EMT
In Rescue Workers
All files require Adobe Logo Adobe Acrobat Reader to view. Click to download.
Patient Information Form
Privacy Information Form
An Explanation of Treatment
Consent for Treatment
Insurance Authorization
Directions to Office
The Memorial
Becoming a Compliant Victim
All files require Adobe Logo Adobe Acrobat Reader to view. Click to download.
Authorization to Release Information
Request for Handling of Health Information
Request for Accounting of Disclosures
Request for Destruction of Treatment Notes