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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Great customer service. Doctor was very informative and made procedure as painless as possible. Staff is very welcoming

Anonymous

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Professional staff who walked me through every phase of my tooth extraction with a calm and caring approach..

Veronica A.

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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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The surgeon and nurses were great. Very helpful in making the right decision and the after care was outstanding.

Brian R.

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

Tamara L.

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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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The staff is very courteous and was gentle with my 89 year old parent.

Anonymous

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Excellent, professional care at this facility.

Jerman F.

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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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Excellent service at a reasonable price. I had to have surgery right away, and they got me inside, got the surgery for much less than I expected to be charged and had an issue later when I got home. The Doctor called me herself, and followed up with me two more times to make sure everything was okay. There was very little pain and the swelling went down when they said it would, I highly recommend…

James M.

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Excellent, attentive and very skillful

Christopher G.

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Everyone in the office was very friendly and informative. Dr. Zadeh is a wonderful oral surgeon. He puts you at ease and explains everything very well. My recovery went exceedingly well, which was a testament to his expertise.

Anthony W.

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Very thorough, and understanding of my concerns. Thanks!

Tim T.

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

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

Michael S.

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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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