March 4th 2019
Planning Your Visit
Appointments: (703) 560-2236
Before the first office appointment, please confirm that the New Consultation Request form was sent by your Referring Provider and received by our office. The Form, detailing the medical problem that needs to be addressed, must be mailed or faxed to us.
A parent or guardian must be present at the visit.
What to bring to your first appointment with the Pediatric Surgical Group
- All radiologic and imaging studies, including the CD with the actual images and the written reports,
- Any discharge summaries provided when discharged after hospitalization,
- A list of medications and allergies, and
- A list of past medical conditions.
New patients are registered in our system and important patient forms are completed prior to the first appointment.
You may bring these forms with you to your initial appointment:
- Registration Form English | Spanish
- Financial Responsibility Statement English | Spanish
- Notice of Privacy Practices English | Spanish
- Consent to Treatment/Acknowledgement of Receipt of Notice of Privacy Practices (for parent/guardian of a minor child) English | Spanish
- Consent to Treatment/Acknowledgement of Receipt of Privacy Practices (for adult patients) English | Spanish
- Medical Permission Form English | Spanish
What to bring to every appointment
- The patient’s current health insurance card(s),
- Proof of identification,
- Copay, if applicable.
Preparing Your Child for Surgery
Information will be provided in order to prepare your child for surgery. Please review any and all documents and forms provided to you in preparing your child for surgery. If you have any questions about the surgery, please discuss with the doctor and/or our staff.
Please contact the Pediatric Surgical Group with any questions about your child’s preparations for surgery.
Inova Children’s Hospital/Inova Fairfax Hospital
The Inova Children’s Hospital offers a brochure, Preparing Your Child for Surgery:
If your child is scheduled for surgery at Inova Children’s Hospital and you are interested in a pre-surgical tour, please contact the Child Life Department at 703-776-3906.
Learn more about pediatric surgery at Inova Children’s Hospital.
Inova Loudoun Hospital
Learn more about Inova Loudoun Hospital Surgery Center.
McLean Surgery Center
Learn more about McLean Surgery Center.
If you have a clinical inquiry, or if you have questions about pre-authorizations, please contact Pediatric Surgical Group at (703) 560-2236.
If you have a question about your bill, please contact our Billing Office at (703) 289-1450.
If you need a copy of your medical records, please click here.