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.

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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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Procedure was quick and efficient.

Richard G.

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DR. LaBriola and his assistants Gaby and Constance were excellent…

William J.

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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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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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Wonderful staff!

Alethea W.

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Excellent staff who were courteous and knowledgeable.

Anonymous

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Great sevice from wonderful individuals-thanks

David M.

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Dr. Jackson takes the time to get to know her patients before the surgical procedure starts. She thoroughly explained the steps of the procedure. She addressed every concern and answered all my questions before the procedure started. She is AWESOME!!

Julia A.

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We love Dr.LaBriola he was so gentle with my daughter when she had her wisdom teeth out. Both of my daughter’s friends went to him too and they said the same thing 😊

Zhulieta D.

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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 have been a patient for many years. Whenever I have needed a tooth removed I have gone to them. My experience has been pain free during the procedure and very little pain or swelling after. I would highly recommend the doctors at Northern Virginia Oral and Maxillofacial Surgery Associates.

Robert J.

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I was very pleased with my experience. Everyone is very personable and calm. All of the staff made me feel welcome and comfortable

Shelley R.

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Oh wow I’m so happy that I went there to extract my tooth.as soon as the dentist start he was done I was so surprised.my detist refer me there because I have high blood pressure he said that he didn’t want to risk taking the tooth out because it’s possible I will have complications.I’m very happy that I went there.I don’t remember the dentist name but he was wonderful…

Shermaine F.

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Very thorough, and understanding of my concerns. Thanks!

Tim T.

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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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I visited the Woodbridge office to have my wisdom teeth extracted. The experience was wonderful. The staff and Dr. Zadeh were professional and kind and did an excellent job. I would highly recommend them.

Anonymous

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Excellent, attentive and very skillful

Christopher G.

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Staff is professional and friendly which made my visit comfortable.

Brenda D.

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Dr. Zadeh and his implant team did an excellent job with my two implants. They all worked to put me at ease which made the procedure stress free. Thank you very much!

Shelley G.

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