We want to make your visit to ACT Wellness Center as pleasant as possible. On Your First Visit, we ask that you arrive 30 minutes prior to your scheduled appointment time to fill out necessary paperwork. To speed up the process you can download and fill out our new patient forms listed below, so you may arrive 15 minutes prior to your scheduled appointment time. This is only a one-time requirement and in order to save you time, we offer them right here for you!
Please Print & Complete Before Your Session:
Email your completed forms to: firstname.lastname@example.org; fax forms to 703-491-2298 or bring them with you to your appointment. Please bring your photo ID and insurance card, if using insurance, to your appointment.
HIPAA (Print only if needed)
You may also use this form to designate who we can disclose your personal health information to
Please be sure to read our Patient Privacy Policies.
If you do not already have Adobe Reader® installed on your computer, Click Here to download.
For Established Patients Only
For every 12 visits in which you are a patient at ACT Wellness Center, we want to monitor how well your overall health has improved. Complete the Re-Evaluation Questionnaire form so we will be able to track your health improvement progress over time.
If you need to cancel an appointment or change the time or date please call as soon as possible. There may be a charge for missed appointments or those cancelled with less than 24 hours notice if we are unable to fill your time slot from our waiting list.
Should you have questions about the forms, please contact our knowledgeable staff for assistance at 703-491-9355. To get an overview of what happens next check out Your First Visit.