New Patient forms

Info For Patients

Dear Patient:

It is with pleasure that we welcome you to Capital Women’s Care. To help your visit go as smoothly as possible, please assist us by bringing the following with you:

  •  Current insurance card(s) or insurance information and Driver’s License or Photo ID.
  •  Insurance referral form, if necessary.
  •  Co-payments are collected upon arrival. We accept cash, check, Visa, MasterCard, and Discover.

Please arrive 20 minutes before your scheduled appointment time to complete the necessary registration information.

Important Reminders

 Capital Women’s Care Division 45 has three offices locations.

  •  3700 Joseph Siewick Dr, Suite 102 Fairfax VA 22033
  •  24430 Stone Springs Blvd, Suite 250 Dulles, VA 20
  •  8644 Sudley Rd, Suite 305 Manassas, VA 20110
  •  15111 Washington St, Suite 121 Haymarket, VA 20169

 We participate with many insurance companies. Please confirm the participation of our providers with your insurance company. Most carriers cooperate with the Virginia mandate that patients have unrestricted access to OB/GYN providers for their women’s health needs. You may want to check with your insurance company to be certain of their policies.

 Please notify our office if there are any changes to the following information: Home Address, Telephone Number(s) or Insurance Information.

 Late Arrivals: If you are more than 15 minutes late for your appointment or we cannot complete the required administrative preparation for your appointment without delaying the other patients, it may be necessary to reschedule you another time. Every effort will be made to be sure you are seen in a timely manner.


For Expectant Parents

For Gynecology Patients

Prescription Refills

Prescription refills are sent to your pharmacy electronically.

You can ask your pharmacist to send an electronic request for refills or feel free to call us for prescription refills during regular business hours.

We make all attempts to send prescription refills by the end of the business day. Prescription refills requested after hours and on weekends will be completed the next business day.

When calling with a refill request, please provide us with the following information: the name and dosage of the medication, pharmacy name and location and a phone number were we can reach you.

Records release policy

Capital Women’s Care maintains patient’s rights wherein all medical records are kept confidential according to all federal and state laws. Federal and state law requires the patient’s signature, or that of an authorized personal representative, to release or transfer medical records. The patient records are defined as all records that relate to the health of the patient and are prepared by or under supervision of a health care provider associated with Capital Women’s Care. Patients who provide records from another physician, outside of CWC, are encouraged to retain their own copy as Capital Women’s Care cannot provide a copy. A fee may be charged for copies of medical records.

Missed Appointment Policy:

We respectfully request that you cancel your scheduled appointment by phone 24- hours in advance. If you do not cancel by the deadline, you may be assessed a $35.00 missed appointment fee. This fee is not covered by insurance carriers and it will be your responsibility to pay. Our aim here is to open otherwise unused appointments for our patients, not to collect missed appointment fees. Your cooperation and consideration is appreciated.

Patient Billing Inquiries

Our patient account representatives are happy to assist you with questions you may have in regards to your statement or the status
of your account. Please feel free to contact them between 8:00am-5:00pm by calling 703-368-1969