Forms for All Patients
- Inova Physician Services patient registration form
- Authorization for claims payment and reviews
- Notice of privacy practices
- Acknowledgment of receipt of notice of privacy practices
- ADA special needs assessment
- Patient Record of Disclosure: Preferred Contacts
- Patient Rights and Responsibilities
- Notice of Non-Discrimination
Medical Release Forms
- Release of medical information form
(To ask Inova to release your medical records to another doctor's office) - Standard medical record release
(To ask another doctor's office to release your records to Inova)
Primary Care Patients – Medical History Form
This form should be completed by all new patients who are seeing an Inova Medical Group primary care provider.
Specialty Care
Our specialty care offices will often have additional forms specific to their practice that they will ask you to complete. Please refer to the online content for your specialty physician's practice to see if other forms may also be requested.
Health Plans Accepted
Aetna
- EPO
- HMO
- Managed Medicaid
- Medicare Advantage
- POS
- PPO
Anthem BlueCross BlueShield
- Exchange
- FEP
- HMO
- Indemnity
- Managed Medicaid
- Medicare Advantage
- POS
- PPO
Behavioral Health Plans
- Beacon Health Options (formerly Value Options)
- Evernorth Behavioral Health (formerly Cigna Behavioral Health)
- Molina Complete Care Behavioral Health (formerly Magellan Behavioral Health)
- Optum Behavioral Health (United)
CareFirst BlueCross BlueShield
- BlueChoice
- Exchange
- FEP
- HMO
- Indemnity
- Medicare Advantage (EGWP plan only)
- POS
- PPO
Cigna
- Exchange
- HMO
- Medicare Advantage
- POS
- PPO
Direct to Employer Plans
- Custom Ink Live Well Health Plan
Exchange Plans
- Anthem
- Carefirst
- Cigna
- Innovation Health
- Optima
- Oscar Health (effective 1/1/2024)
- United
Innovation Health
- Exchange
- HMO
- POS
- PPO
Johns Hopkins US Family Health Plan
- We accept the US Family Health Plan but not the other Johns Hopkins plans
Kaiser Permanente
- Kaiser is only accepted at Inova Fair Oaks Hospital for Obstetrics (OB) services only
- Medicare Advantage at Inova Hospitals only
Managed Medicaid Plans
- Aetna Better Health of Virginia
- Anthem HealthKeepers Plus
- Molina Complete Care
- Optima Health Family/ Optima Health Community Care
- United Healthcare Community Care
- Virginia Premier Elite
MedCost Virginia (formerly Virginia Health Network)
- PPO
Medicare
- Medicare Part A: Hospital services
- Medicare Part B: Physician services
Inova has partnered with eHealth to help our patients find the Medicare coverage that best meets their individual needs. Their licensed insurance advisors specialize in Medicare and understand the Medicare plans we accept.
Call 855-413-5897 (TTY users 711) Monday – Friday: 8 a.m. to 9 p.m. Eastern time to speak to a licensed insurance agent.
eHealthMedicare.com is a non-government website operated by eHealthInsurance Services, Inc., a licensed health insurance agency certified to sell Medicare products.
Medicare Advantage Plans*
- Aetna Medicare Advantage
- Anthem Medicare Advantage
- CareFirst Medicare Advantage (EGWP plan only)
- Cigna Medicare Advantage
- Humana Medicare Advantage
- Molina Medicare Advantage
- Optima Health Medicare Advantage
- United Healthcare Medicare Advantage
- VA Premier Medicare Advantage
* Always check with your insurance provider to verify that Inova is in-network for your plan and for details on your individual level of coverage.
Inova has partnered with eHealth to help our patients find the Medicare coverage that best meets their individual needs. Their licensed insurance advisors specialize in Medicare and understand the Medicare plans we accept.
Call 855-413-5897 (TTY users 711) Monday – Friday: 8 a.m. to 9 p.m. Eastern time to speak to a licensed insurance agent.
eHealthMedicare.com is a non-government website operated by eHealthInsurance Services, Inc., a licensed health insurance agency certified to sell Medicare products.
Multiplan/PHCS
Optima
- Exchange
- HMO
- POS
- PPO
- Medicare Advantage
- Managed Medicaid
Oscar Health (effective 1/1/2024)
Tricare/Humana Military
- Tricare for Life
- Tricare Prime
- Tricare Select
United Healthcare
- Exchange
- HMO
- Managed Medicaid
- Medicare Advantage
- POS
- PPO
- VA-CCN