Downloadable Forms

To reduce your waiting time during your visit, we have provided several forms that you can download, read (and where appropriate, complete and sign) and bring with you. Please see the instructions included on each form.

These forms require the Adobe Acrobat Reader.

Download Acrobat Reader

Downloads

Patient Information and Medical Record

For all new and existing patients. Please complete the online registration form for the office you scheduled an appointment with for your surgical care. Annandale Woodbridge Manassas

Our payment policy

An explanation of the payment policy of Northern Virginia Oral and Maxillofacial Surgery Associates, including options for payment and insurance filing. Please print, read carefully and sign, and bring with you on your visit. Download

Authorization to Release Health Care Information

For any patient who wants to authorize our practice to release their medical information to a third party. Please complete and sign, and mail or deliver to our office. Download

Notice of Privacy Practices for Protected Health Information

A summary of the rules protecting the privacy of your medical information. Please print, read carefully, complete and sign, and bring with you on your visit. Download

Request for Medical / Dental Record

The purpose of this letter is to request copies of your medical records as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations. Download

CareCredit

CareCredit is a healthcare credit card designed for your health and wellness needs. Pay for the costs of many treatments and procedures through convenient monthly payments.

Three Convenient Locations to Serve You

We have three locations in the Northern Virginia area including Annandale, Manassas and Woodbridge. To find an office near you, click the link below.

Find your location

Our patients leave smiling

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I had my wisdom teeth removed by dr.briola he did an amazing job and his staff. They knew i was nervous and they made me feel comfortable explained c everything before doing anything and after care was exception also. I had very little pain and i recommend this office to everyone. Thank you Dr. B AND STAFF.

Melinda M.

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Very happy with the service and professionalism of entire staff. I was able to get an appointment very quickly, procedure was explained clearly, expectations were met and overall experience satisfactory. Made new appointments for mi other children and already recommended your services to friends.

Vincent M.

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So friendly, professional and most of all, very welcoming with the very first warm smile of the office team once I stepped in the clinic! I loved Dr. Julia Jackson’s sense of humor, relieving my nurviousness, not mentioning her and her team’s outstanding listening to patient’s needs, and thorough understanding and support.

Ahmed A.

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Julia Jackson and her staff showed me great kindness. Had an emergency procedure that was taken care of the same day. Dr. Jackson personally called to check on me that same night. It’s comforting to know that there are still professionals that care about their patients. I highly recommend her if you’re in need of her services.

Joann C.

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Everyone at this office was so nice and accommodating. I got sent here from the Manassas office. Dr. Jackson was very detailed in going over the procedure and what to expect. Overall a great experience (well as great as getting your wisdom teeth removed can be)

Sindy A.

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The service was very professional and the doctor was very attentive. The dental assistants made me feel very comfortable because I was very nervous. The wait time was short and the procedure was short as well. They talked me through all the steps before and after my wisdom teeth removal.

Sara F.

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Team Woodbridge, Northern Virginia Oral and Maxillofacial Surgery Associates, Thank you so much for the great experience! Yes, great! From the first phone call until the end of my procedure (4 Wisdom Teeth extracted) – Nice, Professional, Friendly, Engaged, Sincere Care! THE BEST! God bless you all!

Myra M.

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Aside from not remembering much when I got my wisdom teeth pulled (which I completely appreciate), my experience was fantastic. Everything was very quick and thorough. The staff was very professional and provided great customer service. I felt like they were taking care of me.

Kari M.

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