Patient Forms

Thank you for choosing Inova for your healthcare. Our goal is to make your experience as convenient and comfortable as possible. To facilitate the admission and registration process, many of the forms you need to complete prior to your admission or registration for services are now available online.

Inova Alexandria Hospital

• Childbirth pre-admission form

Inova Fairfax Hospital

• Childbirth pre-admission form
• Antenatal pre-registration form
• Pre-surgical assessment form
• Radiation oncology patient forms

Inova Fair Oaks Hospital

• Childbirth pre-admission form
• Sleep Lab at Inova Fair Oaks Hospital
  • General information & frequently asked questions (FAQs)
  • Insurance information
  • Patient questionnaire
  • Preparing for your sleep study

Inova Loudoun Hospital

• Childbirth pre-admission form
• Radiation Oncology forms

Inova Diabetes Services (Inova Center for Wellness and Metabolic Health)

Please visit our website at www.inova.org/diabetes for updated registration forms and instructions.

Inova Heart and Vascular Institute

• Patient admission history
• Medication list

Inova Medical Group Primary Care Practices

• Registration packet for adult primary care patients 
• Registration packet for pediatric primary care patients 

Inova Urgent Care Centers

• Registration packet (English)
• Registration form (Spanish)
• Occupational Health packet (English)  
• Occupational Health registration form (Spanish)
• Workers' Compensation packet (English)
• Immigration packet 
• I-693 instructions
• I-693 form

Inova Physical Therapy Centers

• Registration packet (English)
• Registration packet (Spanish)

Inova Nursing and Rehabilitation Center – Leesburg

• Admission packet

Making Healthcare Decisions

• Virginia Advance Medical Directive Information and Form
• Mental Health Supplement to Advance Directive Information and Form

Request for Medical Records

• Authorization to Release/Disclose Protected Health Information forms in English, Amharic, Arabic, Farsi, Korean, Spanish and Vietnamese

MyChart

• MyChart Proxy Form for Pediatrics

Financial Aid Applications

Inova's Financial Assistance / Charity Care webpage contains information, policies and financial aid forms in several languages. Visit the Financial Assistance page

Inova Well Fitness Classes Required Forms

• For pre- and post-natal participants
• For all other participants

Inova Health Foundation

• Donation form to contribute and pay online 
• Donation form to mail

Inova Wound Healing Center

• Patient registration packet