Patient Forms & Survey

/Patient Forms & Survey
Patient Forms & Survey

Welcome and thank you for selecting The Kaplan Center as your healthcare provider! We look forward to helping you optimize your body’s ability to heal itself.

On this page you can access all of the forms that new patients must complete. If you have any questions about the forms below, please call our office at 703-532-4892.

1. Download the New Patient Packet

NOTE: Pages 2 thru 5 of the New Patient Packet are interactive, including a digital signature. You will be able fill out pages 2-5 directly on your computer (though not required) and then print the document in its entirety as the remaining pages must filled out by hand. You must download and save the document to your computer and open with Adobe Reader or Acrobat in order to use the the digital signature. We are working on improving this issue.

2. Download the Patient Authorization Form

NOTE: This document is interactive, including a digital signature. For the interactive features to work, download the document to your computer, open with Adobe Reader or Acrobat. If you open it in your browser, these features may not work correctly.

3. View and print our Visitor Information Packet
4. Feedback Form

We’d love your feedback! Please let us know how you found us by taking a moment to complete our New Patient Survey below.