Cardinal Internal Medicine Patient Resources

Cardinal Internal Medicine aims to deliver the safest and most efficient patient care possible. To reduce your waiting time during your initial appointment, we ask that new patients download, print, and complete the forms located in the New Patient Information section.

New Patient Information

Please bring the original signed copies of the forms here, along with your Insurance card on your visit. Please note that you will need to download and install Adobe Reader to view and print these forms.

New Patient Forms

Patient Registration Form. The Patient Registration Form contains your personal and insurance information.
Privacy Policy. Please read completely, sign/date the signature page and bring it with you to your appointment.
Deemed Consent Form for HIV/Hepatitis B & C. Please sign/date and bring with you to your appointment.
Patient Medical History Form. Contains your medical history and updated medical information.

New Patient Forms - Cardinal Medical Weight Loss Center

Medical Weight Loss Patient Questionnaire. Cardinal Medical Weight Loss Center patient intake form.
Medical Weight Loss Release and Patient Informed Consent. Acknowledgment and consent of risks and your patient rights.
Insurance Waiver. Acknolwedgement that medical weight loss services are not covered by medical insurance.

HIPAA Privacy Policy

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions about this notice, please contact Dr. Sohail Moussavi at 703-497-4700.

Cardinal Internal Medicine Privacy Policy