New Patient Registration

Thank you for choosing Virginia Spine Specialists for your Spinal Care needs. We know you have a lot of choices in choosing your healthcare providers, and we consider it a privilege to be a part of your health care support team.

Below are some important facts that you need to know in order to facilitate your appointment in a timely fashion.

• Please plan to arrive approximately (30) minutes prior to your scheduled appointment to allow time for you to sign consent forms that are required for your treatment.
• Please complete all questionnaires on your Patient Portal.
• The following will be requited for your 1^st visit at VSS:
  • New patient packet
  • Driver’s License
  • Insurance cards
  • Imaging (MRI, CT, and or X-rays) ON A CD.
  • All medical records relating to the treatment for this condition.
  • If you have prior surgery, we would need to have a copy of the Operative Report.

REFERRAL POLICY

• As a new patient your insurance may require a “Insurance Referral” to be provided for you to be seen in our office and prior to testing. We recommend that all patients call and confirm this directly with your health insurance or check with your PCP office ahead of time.
• If an “Insurance Referral” has not been obtained before your appointment, you will be asked to sign a “Waiver Form” acknowledging that if the Referral is not able to be obtained timely I will be financially responsible for the charges incurred.
• For any non-insured patients, fees for all office visits and related charges are payable at the time of service. New patient visits range from $300-$600.

CANCELLATION POLICY

• Office visit appointments not cancelled within (24) business hours will be charged a $50.00 cancellation fee. 
• Surgical procedures not cancelled within 7 business days will be charged $200.00 cancellation fee. This does not apply if you are not cleared for surgery. 
• If you must cancel or reschedule your appointment, we ask that you contact us directly at (571) 921-4877. Monday – Thursday 8:00am – 4:00pm and Friday 8:00am – 4:00pm
• We offer a 15 minute grace period. If you show for your appointment after that period, your appointment will be cancelled or rescheduled. NO EXCEPTIONS!
• If you no-show 3 times, you will be discharged from our practice.

My staff and I appreciate you selecting our office for your health care. We recognize the trust and responsibility placed in us and we will do everything possible to provide for those needs. We look forward to seeing you!

Sincerely,
Dr. Sharma, MD & VSS Staff

Optional printable forms:

1. VSS Medical Records Request
2. HIPAA Patient Privacy Practices (copy for patients)

Any question, please call (571) 921-4877