For Patients
Patient Forms
For NEW patients, all of the following forms must be filled out and submitted at least 48 hours prior to your office appointment. Failure to do so will forfeit your appointment resulting in a cancellation. It is recommended to call the office to ensure that your forms have been received and to confirm your appointment time.
You can fill in the data online but it must be printed or saved as an attachment in order to fax to (703) 256-6566 or email to info@nvhb.org
Intake Form
Pediatric Intake Form
Credit Card Authorization Form
IASIS Consent Form
Symptom Survey
Private Policy Form
Medicare Form
For auto accident visits, the following form must be filled out
Auto Accident Questionnaire
Frequently Asked Questions
Office Policies
We require 24 hour advance notice of cancellation or rescheduling.
The charge for a missed chiropractic appointment is $50 and for a missed medical appointment, $100.
Payment plans
Payment in full is required at the time of service. Dr. Fuller is not in network with any insurance plans. Dr. Kim is an out of network provider and nonparticipating for Medicare. Medicare patients will need to sign a waiver. We will provide you a superbill which you can submit to your insurance company for reimbursement.
Our core values
Quality
Good care involves more than managing symptoms. Result oriented care necessitates a holistic approach.
Empathy
We understand that communication starts with listening and being understood, caring about you as an individual, not just a list of diagnoses.
Accessibility
Often, a barrier to good communication is having to go through intermediaries. Direct communication with your provider is encouraged and valued.
Healing
We are facilitators in a whole person approach that recognizes the innate capacity for the body to restore itself to a state of well-being.
Schedule your appointment
We look forward to hearing from you.
Give us a call: