Call Us Now: 703-890-2222

Email Us: fairfaxclinic@kaizo-health.com

Download Patients Form

Complete Your Paperwork Ahead of Time!

Find the required forms below, and have them ready for your first appointment so you can get seen by the doctor sooner.

Please Read our HIPAA Privacy Policy.

STEP 1: Download Pain Area Form

Neck

If you are being seen for your neck. Download this form.

Download Form

Shoulder

If you are being seen for your shoulder. Download this form.

Download Form

Arm, Wrist

If you are being seen for your arm, wrist, or hand. Download this form.

Download Form

Back or Hips

If you are being seen for your back or hips. Download this form.

Download Form

Leg, Ankle, or Foot

If you are being seen for your leg, ankle, or foot. Download this form.

Download Form

STEP 2: Injury Related to Motor Vehicle Accident?

If your injury is related to a motor vehicle accident, another type of accident, or is related to a worker’s compensation case please download and fill out the following paperwork that applies to you IN ADDITION TO THE ABOVE FORMS. Please bring them with you to your first appointment

If the injury is NOT related to a motor vehicle accident, move on to step 3.

If you were involved in an auto-accident and you live in Virginia or DC, please fill out the following forms:

VA Motor Vehicle Accident Paperwork

Notice to Motor Vehicle Accident Injury Patients in Virginia

If you were involved in an auto-accident and you live in Maryland, please also fill out the following forms:

MD Motor Vehicle Accident Paperwork

And/Or If you were involved in a Worker’s Compensation Accident, please fill out the following forms:

Worker’s Compensation Form

STEP 3: For Patients under 18

Is the Patient a Minor? If so, download: Consent to Treat a Minor.

If not, then you are done! Please bring all forms to your appointment.

Our Core Values

Brilliance .

We do our very best for each other, our patients, and the partners we serve.

Synergy.
We act in unity to ensure the experience is greater than the sum of its parts.

Human-Centered.
Your mind, body and spirit is at the center of everything we do.

Tenacity.
We fight social injustices to protect access to evidence-based care.

Passion.
We are driven by the positive and powerful impact of our work.