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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This letter is to follow-up with you sharing my experience before and after regarding being diagnosed at your office with Arthritis and describing pain in my jaw, ear, and neck pain etc. In the course of about a year, I went to urgent care, ear and throat specialists, twice to a dentist, two times to a primary care provider, had a sleep apnea test, hearing test and finally coming to your practice.…

Cecilia G.

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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 doctor was very nice and very concern about me.

Rose C.

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Very thorough, and understanding of my concerns. Thanks!

Tim T.

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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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Excellent staff who were courteous and knowledgeable.

Anonymous

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Excellent, professional care at this facility.

Jerman F.

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By far the best experience I have had. My procedure was quick and I was in and out. Everyone was very nice and helped ease my nerves. I couldn’t have asked for a better experience. Dr. Zadeh is the best!

Nakeecha W.

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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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Thank you for having forms early to fill out with ink! They provided large enough spaces for me to be able to fill out correctly! Kanlaya was very friendly and understanding while setting up my appointment! Thank you Donna for helping me relax before the extraction! Your calming tone was great from my nerves. Truc, thank you for being very quick with my checkout!

Mindy B.

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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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Everyone friendly, helpful, knowledgeable , professional . No problem with scheduling. Had extraction with no ensuing pain, swelling or discoloration.

Anonymous

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Great staff. Dr. Jackson was also great. Very professional but personable and answered all my questions with patience.

Melissa K.

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The staff made me feel comfortable, cause I was scared & don’t like needles.

Tamara L.

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The staff were very helpful and friendly. Dr. Yadav was excellent and his assistantance were great.

Hazel B.

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Dr. Labriola was above and beyond excellent. I had four wisdom teeth removed and a root canal yesterday and have had virtually no pain or swelling. The recovery has been extraordinary. Dr. Labriola and his staff are true professionals, if you are considering this practice look no further! My procedure was painless and comfortable!

Erika B.

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I had all 4 wisdom teeth removed yesterday by Dr. Zadeh. I was very nervous because this was my first surgery ever. All of the staff was was great and explained every step including the sedation process and aftercare instructions. Before I took any medication, my pain was a 3/4 out of 10. This was a very positive experience and I highly recommend this practice.

Deandras W.

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It such a pleasure working with Dr. Jackson and the crew. You all are amazing.

Maria S.

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I got more than I expected today. I was in pain, afraid, and unsure about how to best deal with the painful experience in my teeth. Everyone from the front desk to Dr. LaBriola exceed expectations I had. Thank you and may your business thrive!

Mekdes K.

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My son had all wisdom teeth pulled out and the procedure went smoothly. Treatment plan was explained, staff ( from secretary to the Doctor) was friendly and knowledgeable. I recommend this clinic for dental care. Thank you!

Nikki M.

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