Patient Forms

Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.

After Hours

Your After Hours Care Options

  1.   Mount Vernon Internal Medicine’s hours are generally 8am to 5pm, however, we offer extended hours Monday and Tuesday at the Alexandria Office until 7pm.
  2. Our phones are open from 7am to 6:30 pm Monday and Tuesday also so that we are able to assist with your medical needs.
  3.  For urgent needs after office hours there is a physician from the practice on call that can be contacted through our answering service by calling our main number 703-780-2800. The physician on call will contact you within 15 minutes. Please note you may be charged a $25.00 fee for use of the after hour’s line.
  4.  Please DO NOT use patient portal messaging for urgent issues on the weekend or after hours. Those messages will not be received or returned during non-office hours. Messages received during non-office hours will be returned the next business day.
  5.  If you do not feel your symptoms require an emergency room visit, but require medical attention on the weekend or when our office is closed, please head to the nearest urgent care office. Please note we are not affiliated with these Urgent care offices and it is your choice where you seek care.
  6. To see a list of Urgent or Immediate Care Offices near you, click here.

To help you determine what type of after hours care is appropriate, please use the following guidelines below. Please note this is a SUGGESTION of treatment and not a requirement:

Useful Links

Visit the NCQA website for more information on a patient centered medical home and what it means for you. 






USDA: Community Nutrition Information

Local Food Pantry Information

NIH Nutrition Tools and Resources

American Heart Association: Tips for Healthy Living

*Please contact the office to schedule an appointment with our Diet and Nutrition Educator*


CDC: Smoking and Tobacco Use

Quit Smoking Community

Smoking Cessation Programs and Resources


Smart Nutrition Starts Here CDC Healthy Weight

American Medical Association: Physician and Patient Resources on Obesity Management and Prevention

Move Weight Management Program

*Please contact the office to schedule an appointment with our Diet and Nutrition Educator*


Men’s Checklist

Women’s Checklist


Hypertension [PDF]

Diabetes Oral Medication Log [PDF]

Diabetes Insulin Log [PDF]


Community Transportation Association Virginia Easy Access


Good Rx: Stop paying too much for your prescriptions

PPA: Prescription Assistance Program


CDC: Physical Activity

Exercise Programs That Promote Senior Fitness

Your Everyday Guide from the National Institute on Aging


Fall Prevention Information from the CDC



Authorized Durable DNR Form (VA Department of Health)


Straightforward, honest, health insurance quotes. Just for you.

Get a free insurance quote.

DEA Controlled Substance Disposal Site

If you would like to return unused narcotics, the Drug Enforcement Administration has created a website to find nearby controlled disposal locatons.  After entering your zipcode, the site will list all locations within a 50 mile radius.

External Content Disclaimer

*Please note that pages of this site may be linked to other websites, which may have different terms of use and privacy practices than Privia Medical Group. Privia does not own, control, manage, supervise, direct, or otherwise have involvement in such other websites or the content of such websites. Privia is not responsible for the content of any linked websites. Privia is not acting as an agent for these websites, nor does Privia endorse or guarantee, in any way, their websites, content, or products. Privia makes no representation or warranty regarding the accuracy of information contained in linked websites, takes no responsibility for the use of copyrighted or otherwise protected materials on such linked websites, and has no control over the privacy practices or use of user information at such linked websites.

Frequently Asked Questions


1. Do I need to schedule an appointment?

Yes – all patients are seen by appointments. In case of an emergency, you will be seen within 24 hours by the next available provider.

2. What do I need to do as a new patient?

Please arrive 15 minutes prior to your first appointment to fill out forms and so we can verify your insurance.

3. What do I need to do before I see the doctor?

All patients are seen by appointments. Upon arrival, please be sure to sign in at the front desk. Inform the receptionist of any changes in address, phone number or insurance information. Patients are called by order of appointment time as long as patients are present.

4. What do I need to do when I am done with the doctor?

Check with the front desk receptionist to :

  • Retrieve any referrals or orders if not given by the physician during the visit
  • Schedule your follow-up appointment
  • Schedule testing if necessary
  • Pay your co-pay or deductible if you did not at check in.

5. How do you notify the patient with the test results?

Normally, the doctor will discuss the results of the tests during the follow up visit.

6. How long does it take for the doctor to receive the test result back?

We normally receive results within 5-7 business days. Xrays and other testing results are sent out to be read. We receive them back in 7 to 10 business days. 

7. Am I informed or reminded when my appointment is?

Yes, our office will send you a reminder baised on your preferred contact method 48 hours in advance of your appointment.

9. What do I do if I can’t make it to my appointment?

Please call and cancel your appointment within 24 hours. Otherwise, you will be charged a fee.


An important aspect of having a managed care health plan or HMO Insurance is having your primary care physician assess your health care needs. This step helps your provider to clarify your medical record to properly diagnose the problem and to give you a better chance of being referred to the most appropriate specialty physician.

**If you seek the services of a specialist without a prior authorized referral, you may be held financially responsible for the entire specialty service.**

Our Referral Specialists can assist with the HMO Referral Process. You can contact the office and request a referral authorization prior to any specialty service being rendered. If your insurance requires we process a referral, we must document the required criteria before processing the referral. If the criteria is met, the referral authorization must be requested and received prior to your specialist visit. It is the patient’s responsibility to become familiar with their insurance policy and its requirements for obtaining referrals.

So that we may accommodate your requests and needs in a professionally efficient and timely matter we ask that you familiarize yourself with Mount Vernon Internal Medicine’s Referral Policy below. If you have any questions regarding the policy, please ask for clarification.

Mount Vernon Internal Medicine Referral Policy

– A minimum of 5-10 business daysis needed for this office to process non-emergency referral requests.
– Emergency referrals will be handled as quickly as possible.
– It is the patient’s responsibility to make sure that they have complied with the referral policy guidelines of our office and have met the requirements mandated by their health plan. The patient must have an approved and completed referral form or authorization number in hand PRIOR to examination by a specialist or testing performed.
– Retroactive Referrals WILL NOT be issued. If you are seen by a specialist or facility without the proper referral, your insurance carrier will most likely deny coverage and you will be responsible for charges incurred. If you receive treatment in a hospital emergency room or urgent care facility during a weekend, holiday or after hours, you must report this to our office on the first business day following treatment, so we can provide proper authorization to that facility.
– If a specialist refers you to another physician or facility you must contact our office for that referral.

How to Obtain a Referral:

  1. Select a specialist – contact your insurance carrier for an In-Network provider listing or ask our staff for a list of recommended specialists in the area to compare.
  2. Call the specialist’s office and make an appointment (be sure you give yourself at least 48 hours before the appointment so you can obtain a referral) – verify that the specialist is PARTICIPATING with your insurance plan.
  3. IMMEDIATELY call our office at (703) 780-2800 and select the option for the referrals. If it goes to voicemail please speaking slowly and clearly, and leave the following information:
    – Your full name (spelling out your last name) and date of birth.
    – A phone number where you can be reached or where a message can be left.
    – Name and phone number of the specialist you will be seeing (please give the address if you have it available).
    – The reason for your visit to the specialist, the date and time of your appointment.
    – Please state whether you will be picking up the referral from the front desk or if you prefer it mailed to your home.

Specialist Follow-Up Referral Requests

In order to ensure the processing for a referral plan authorization, we request that you contact the office at minimum of 5-10 business days ahead of any scheduled appointments. If the Referrals Specialist does not have enough notice, they will not be able to process same-day referrals requests. Therefore, you may be required to reschedule your specialty care appointment or be held financially responsible.

Become a Patient

Whether you are new to the area or currently are not established with a primary care provider, look no further! Mount Vernon Internal Medicine has highly qualified Physicians and Nurse Practitioners who are available to help.

Please review the provider photos and biographies on our Meet the Team page.

If you have questions please contact our call center representatives for guidance on which provider is the best fit for you at 703.780.2800.


1. Your current Insurance Card and a valid Photo ID. We follow very strict privacy guidelines. In order to protect our patient’s identity and prevent fraud, we require both of these at the time of your appointment.

2. Completed Care Visit Form which will include:
– A list of providers/specialists from whom you receive care.
– A list of your medications and their dosages; both over the counter and prescribed.
– A list of your previous surgeries or conditions that you have received treatment for.

3. Your vaccination record.

Please arrive 30 minutes prior to your scheduled appointment time to allow us time to verify your information and fill out any necessary paperwork. To provide top notch care, we like to know who our patients are and to be able to fulfill this, we will ask you about your family history and other vital background information during your first appointment.

** If you have a HMO insurance and another provider’s name is listed as your PCP on your card please call your insurance company to have this changed before coming in for your appointment. Unfortunately, insurance companies do not allow us to make this change on your behalf.

** If you are receiving care due to an injury covered by a Workman’s Compensation Insurance, please note, you must contact your case worker before your appointment and receive authorization to see us. We will need your claim number, authorization number, case worker’s contact information and the name, address and phone number of the Insurance Carrier.

Our providers will be delighted to fill out any medical forms for patients. However, in order to do this, ample time must be given. It will take approximately one to two business days for the forms to be completed. You will need to let us know how you would like to receive your medical forms. Please see the Authorization For Release Of Medical Information form below for more information.