Office address:

(as of Oct. 1, 2018)

 

19415 Deerfield Avenue

Suite 213

Lansdowne, Virginia 20176

 

Phone: 703-724-9474


Fax: 571-346-1921

Patient Forms

PLEASE MAKE SURE YOU SCROLL DOWN AND READ THIS ENTIRE SECTION.

Dr. Chiantella's practice is managed by Loudoun Medical Group. You may see this on some of the registration documents.

 

NEW PATIENTS: Please print and complete the registration forms below. These documents can not be completed online. Please bring your completed forms to your appointment, and please arrive at least 15 minutes ahead of your appointment time. DO NOT EMAIL THESE FORMS as this is private information and your outgoing emails are not encrypted. If you prefer to complete the forms in the office, before your appointment, please arrive 45 minutes early, and we will provide the forms for you at that time.

 

RETURNING PATIENTS: Please arrive 15 minutes before your appointment time. There are no online documents for you to complete. (Yay!)

This is what you need to bring to your appointment:

--Your current insurance card and photo ID.

--A list of all your medications, including name, strength, and dose of each medicine and supplement

--Your last 3 years of breast imaging: mammograms, breast ultrasounds (sonograms), and breast MRIs. PLEASE NOTE: In order to evaluate you thoroughly, you must bring the actual IMAGES from these studies, not just the reports.  Most imaging centers require 48 hours to prepare your imaging for pickup.  UNFORTUNATELY, many imaging sites are getting away from printing mammograms onto sheets of film. Film is the MUCH PREFERRED way to look at a mammogram.  Important detail can be lost when a mammogram is placed on a CD.  We are happy to have your MRI or Ultrasound/sonogram images on a CD.    Virginia Hospital Center, Prince William Medical Center, Inova Loudoun Hospital, Winchester Medical Center, Loudoun Imaging Center-Ashburn, and Fair Oaks Imaging Center will not provide mammograms on film, there is no choice but to take a CD from these locations. Only the Lansdowne office of RIA prints films, the CountrySide office does not.  Washington Radiology and the Women's Imaging Center in Reston DO print images onto film, and some, but not all, Fairfax radiology sites can print films as well.  When you call to ask for your imaging, please inquire if you can get your mammograms on film, just in case something changes at any of these sites.

 

It is a common misunderstanding that imaging centers mail actual images to the office. Unless you have relocated and your imaging was done out of the area, local imaging centers do not send images through the mail.

 

In summary, here is a film pickup check list for you to use to ask the radiology staff when you are at the imaging center to pick up your studies:  

---Are my last 3 years of breast imaging of all types in this envelope?

---Please open the envelope and check the dates with me.

---Are the mammograms on film and not on CD, if the center does still print films?

 

Again, you are coming to your visit to have a thorough evaluation. It can not be done if the information necessary for that evaluation is not provided. The appointment will need to be rescheduled if the imaging is not available at the time of the appointment. Please call us ahead of time if you have any questions at all about this, or you need assistance with what you might need to bring, or how to obtain it. We are here to help you. We hate having to reschedule appointments when a patient arives unprepared, but it must be done to provide best service.

NewPtPacket.pdf
Adobe Acrobat document [4.3 MB]

We accept most types of health insurance. Please contact us for further details, or if you have any questions at all regarding your appointment.

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© Virginia Chiantella MD