Before your appointment we’d like to have some information on your current and past medical history, eating habits, lifestyle and activity level. Please take a second and download the form below. Then print it out and fill it in to the best of your ability. Make sure to bring the completed form to your appointment, or fax it to us at (703) 558 – 4980.
Download the Medical History Form by right clicking on the link below ⇩
Form for men
Monday and Wednesday 9:00 a.m. until 6:00 p.m.
Tuesday and Thursday 9:00 a.m. until 4:00 p.m.
Closed for lunch from 2:00 p.m. until 3:00 p.m.
Closed Friday and Saturday
HIPAA Privacy Rule
The office of Denise E. Bruner, M.D. & Associates, P.C. is required by law to maintain the privacy of protected health information, records and individuals with the notice of its legal duties and Privacy practices with respect to protected health information and records. This office is required to abide by the terms of the Notice currently in effect. Learn more about HIPAA from the Dept. of Health and Human Services.
The office of Denise E. Bruner, M.D. & Associates, P.C. will specify and provide a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity and availability of electronic protected health information.
Our time is just a valuable as yours and we do our best to respect your time. If you are unable to keep an appointment, please let us know at least 24 hours prior to your scheduled time. We reserve the right to charge a fee for appointments not cancelled with ample notice. If you are going to be more than 15 minutes late for your appointment, we ask that you call the office as we may need to reschedule your appointment.
Charges will be payable at the time of each visit. The patient is liable for all charges. We accept MasterCard, Visa, American Express, personal checks, or cash.
Denise E. Bruner, M.D. & Associates, P.C. does not participate with any insurance carriers. Visits and treatments that are approved by your insurance carrier may receive some coverage under your insurance benefits. In these cases, you may file an insurance claim yourself. We will provide you with a “Super Bill” to include with your claim submission. A “Super Bill” is a medical receipt which includes procedure and diagnostic codes.
It is your responsibility to submit any insurance claims.
Office visit courtesy
In consideration of all of our guests and staff, we ask that you either turn off your cell phone or use the vibrate setting when you are visiting Denise E. Bruner, M.D. & Associates, P.C. We love children and pets too, but it is important that they are supervised at all times when in our office.
Our office has plenty of free parking in the lot behind our office building.
5275 Lee Highway, Suite 101
Arlington, Virginia 22207