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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Dr. Zadeh is not only a very qualified oral surgeon, he is a very warm and easy to communicate with kind of person. I had a lower canine that had been root-canaled some time ago and ended up having a painful infection. He took out my infected tooth like he pulled out a needle from a butter, not feeling any pain at all. He then placed an imediate implant. He is very efficient in using his time and…

Zufan H.

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I had a wonderful experience. Before the surgery I was very nervous but the surgeon and dental hygienist made me feel a little more comfortable for the procedure.

Meshala M.

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The staff was wonderful, helped me relax and told me a lot to details of how the procedure will be. I’ve never had surgery before but they explained what will happen and gave me good advice. After the surgery, they helped me to get settle after the procedure and gave in detail of how to care for myself after the surgery. Thanks to Dr. LaBriola and the staff for making my first oral surgery c…

Sharie B.

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Dr. Jackson was extremely professional, patient, informative as well as friendly and enjoyable. She explained everything in great detail before my procedure. My personal dentist, Dr. Jones, recommended her. I knew if Dr. Jones recommended her she had to be great. My procedure was exactly as she explained. Her assistant Rosemary was also wonderful. I highly recommend Dr. Jackson to anyone reading t…

Maria S.

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Very pleasant and helpful people. The doctor that did my daughters surgery explained everything. Has a great bedside manner. Just want to thank them for all they do. I pray many blessings over you all.

Connie D.

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It was the best experience. The workers were very friendly and made me feel comfortable.

Gertiude O.

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Excellent staff who were courteous and knowledgeable.

Anonymous

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My first visit was great! Everyone was really nice and welcoming. They made me feel very comfortable.

Breana O.

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Great experience. Everyone was calm and very reassuring during both my consultation and wisdom teeth removal visit. Despite my anxiety, everyone spent their time seeing if I had questions and tried to create a relaxing atmosphere before I had to go through with the surgery. Highly recommend anyone coming here. Clean and modern office with a 10/10 experience throughout.

Jennifer T.

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It is my first time in this place I was treated with a professional the girls who are at the front all very kindly make it feel like at home very friendly nurses and doctors

Marta H.

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Was able to be seen on very short notice – referred from primary dentist. Each of the four or five office staff members plus the dental assistants and the doctor I saw were courteous and professional and each clearly very knowledgeable in their respective areas. Evaluation and explanation of my needs was quick, efficient, thorough and clearly explained. I can’t imagine a better oral su…

Dan E.

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I felt very confident that I was in a professional environment and that my doctor new exactly what he was doing.

Anonymous

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Very professional and knowledgeable staff. I would 100% recommend this practice. The staff very thoroughly communicated with us, not only about the procedures, but also about the billing. I felt like my son was in the best hands for his wisdom teeth extraction. Thank you for making this a smooth process!

Anonymous

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Excellent service. Dr. Haron is an experienced professional to trust with my dental health. Offer staff were nice and friendly. Thank you

Hagop A.

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My son recently got his wisdom teeth extracted. Dr. Zaheh made my son feel very comfortable and relaxed. The procedure did not last long at all which led to a quick recovery. My son had absolutely no swelling which was unbelievable! He hardly experienced any pain either. He went out with friends a few days later and will recommend others to Dr. Zadeh!

Darlene Y.

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Procedure was quick and efficient.

Richard G.

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Had not had a tooth pulled in about 50 years so really could not remember what to expect. Things went pretty smoothly I’m pleased to report. Was sorry to hear that BC/BS stopped covering tooth extractions in 2015! Glad to have the infected tooth out of my mouth…appreciate being taken by your practice on short notice.

Barbara B.

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Unfortunately we had to be seen for an emergency situation. Dr. Haron was very thorough with informing us of what was to be expected. He was spot on with what happened and what he told us to expect. His calm, gentle demeanor was quite settling for us.

Anonymous

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Very friendly and professional staff. Did an excellent job with a tooth extraction I needed.

Michael S.

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Excellent surgeon, dental assistant and front desk staff. Thank you! *Revised review 6/27/17*

Pamela M.

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