Office alert: Edit this message to tell patients about a closure, weather delay or change in hours.

Office alert: Edit this message to tell patients about a closure, weather delay or change in hours.

Patient Forms

Please review and complete the forms below before your visit to Vista Medical Center. The links open the latest version of each form from Privia Medical Group, so you always have the current copy. You can bring completed forms to any of our offices in Crystal City, North Arlington or Annandale. Questions about coverage? See our insurance page or self-pay options.

Forms for Your Visit

Notice of Privacy Practices

Describes how health information about you, as a patient of Vista Medical Center, may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.

Authorization for Release of Medical Information

Allows patients to authorize the disclosure of their health information to a designated individual, company, agency or facility.

Authorization and Consent for Treatment

All patients must provide their consent for treatment, communications (calls, emails and text messaging) and agreement of financial responsibility.

Preferred Contacts

Patients are encouraged to complete and return the Preferred Contacts Form, but it is not required.

Financial Policy

Advises patients of their complete financial responsibility for all medical services received, without regard to insurance eligibility or coverage determinations.

Language Services

Free language assistance and information about our nondiscrimination policy for patients who need help in a language other than English.

Patient Portal and MyPrivia App

Use the MyPrivia patient portal to view test results, message your care team and manage your health information online.