Patient Registration

After you’ve requested an appointment time, you can complete form tabs 1-3 below to save time when you arrive:

  • Tab 1: New Patient Form

  • Tab 2: Parent Guardian Consent Form

  • Tab 3: COVID-19 Screening Form

Please also fill out any other forms that are applicable for your visit:

  • Tab 4: HIPAA Acknowledgment

  • Tab 5: Payment Policy

 

Our Office

Mariah Shojaei Endodontics

46161 Westlake Dr, Suite 120
Sterling, VA 20165