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

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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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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I received excellent treatment. I would highly recommend this oral surgeon.

Antonio 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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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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Well first off I have a fear of Dentistry. But the staff at Northern Virginia oral maxillofacial surgery put that completely at ease. This was the first and only time that I had dental work done without any fear or any pain. The front end staff is top notch..(Wendy & Gloria)..every question from procedures to payment was handled extremely well….I cant thank everyone enough..

Robert D.

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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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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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Had a really good experience !

Deepti K.

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Excellent staff who were courteous and knowledgeable.

Anonymous

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Wonderful staff!

Alethea W.

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Awesome people! I had my reservations based on some yelp reviews [mostly concerning other issues other than the procedure itself]. So I went in with an open mind not really concerning myself with anything else other than getting my four wisdom tooth extracted. I came out pleasantly surprised at how professional and cautious the staff were. I was able to walk to my car unaided, did prescription run…

Bendu F.

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Went here for a second consult on my sons wisdom teeth removal. The staff at the front desk was very friendly and welcoming. Dr. Zadeh was very friendly and informative. After our consult visit I decided to go with this practice. The day of the surgery went very smooth. This practice is very organized and everyone worked together as a unified team to ensure that from start to finish there were no…

Jamie B.

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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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I was overall impressed by the friendliness and professionalism of the staff from reception all through checkout. I was seen by Dr. Haron, he was extremely pleasant and knowledgeable. He answered all my questions and provided me with several options. He was very straight forward in regards to what each option will offer and the chances of success. I highly recommend NVOMSA.

Amer G.

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Best oral surgeon office in the DC area! Dr. LaBriloa is an amazing doctor and is the greatest!

Dimitri G.

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

Gertiude O.

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I called for an appointment in Manassas and they were able to see me that afternoon.

Leonard J.

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