Please print and email the consent form to our office email: mpc.mathur@gmail.com

Consent Form


Health Insurance Forms

Insurance & Forms

We accept the following insurances:

  • Aetna
  • Cigna (Except a few plans)
  • VA Medicaid
  • Anthem Health Keepers/Plus
  • Care First Blue Cross
  • Blue Cross/Blue Shield
  • Tricare
  • Coventry
  • Optima Choice
  • United (only PPO, NOT HMO)
  • Medicare
  • Humana (Except Humana Medicare)
  • Workers Comp

We also accept payments by cash, check, or credit cards.

For self-pay patients, our consultation fee is $120 plus an additional fee if blood work or other services are provided.

PLEASE VERIFY WITH YOUR INSURANCE COMPANY THAT WE ARE IN YOUR NETWORK. WE MAY ACCEPT YOUR INSURANCE; HOWEVER, THERE ARE HUNDREDS OF "PLANS" WITHIN YOUR INSURANCE, AND WITH SOME OF THOSE "PLANS" WE MAY BE OUT OF NETWORK. THAT MEANS A HIGHER OUT OF POCKET COST OF YOU. THE BEST METHOD TO MAKE SURE THAT WE ARE IN-NETWORK WITH YOUR PLAN IS FOR YOU TO CALL YOUR INSURANCE COMPANY AND GET THEM THE VERIFY THAT WE ARE IN-NETWORK FOR YOUR PARTICULAR PLAN WITHIN YOUR INSURANCE.


Online Forms

Please follow the links provided below:

Contact our office in Manassas, Virginia, for your preventative health needs.