Welcome to Your Child’s Health Home
Expert Pediatric Care
Expert Pediatric Care
Comprehensive Services
Comprehensive Services
Family-Centered Approach
Family-Centered Approach
Holistic Wellness Programs
Holistic Wellness Programs
Warm and Welcoming Environment
Warm and Welcoming Environment
Patient Education
Patient Education

Schedule a visit with us today!
BECOME NEW PATIENTS
- Make an Appointment
- Sign up for our patient porta
- Download your patient forms online through the patient portal
When you come to our office for the first time as a new patient, we’ll ask you to complete some initial forms, including an Authorization and Consent for Treatment form, if you were not able to download them from the patient portal in advance of your appointment.
To make sure there are no delays in care during your first visit experience, please arrive 15 minutes prior to your scheduled appointment to ensure your registration is complete before meeting with your new provider.
WHAT TO BRING TO YOUR APPOINTMENT
- Your insurance card
- Valid photo ID
- List of current medications
- Office co-pay
In an effort to respect the time of all of patients, our staff strives to stay on schedule so that other patients do not have to wait.
For patients who are delayed and arrive late for their appointments, every effort will be made to see them the same day. However, wait times may apply, or appointments may need to be rescheduled. Please see our office fees.

PATIENT FORMS
- Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
- Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
- Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
- Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.

OFFICE POLICY FORMS
- Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Política Financiera (PDF)
- Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully. Aviso de prácticas de privacidad (PDF)
- HIPAA Privacy Notice
OTHER OFFICE FORMS
Printable Forms
Adobe Reader version 10.1.2 or later is required to view printable forms. There is a known problem with
version 10.1.1.
Download Adobe Reader for free
- Preferred Contact and Method of Communication Form
- Patient Registration Form
- HIPAA Privacy Notice - Spanish
- Consent to Treat - Spanish
- Patient Registration Form - Spanish
- Financial Policy
- Notice of Privacy Practices
- Authorization and Consent
- Authorization and Consent to Treatment Form
- HIPAA Authorization to Release PHI
- HIPAA Authorization to Release PHI SP
- Patient Access Records Self/Third Party
- Patient Access Records Self/Third Party SP
- Preferred Contact and Method of Communication
- HIPAA Contact Information
- HIPAA Contact Information Sp
- Medical Record Request English
- Medical Record Request Spanish
- Advance Directive
- Audiogram
OTHER OFFICE FORMS
- Preferred Contact and Method of Communication Form
- Patient Registration Form
- HIPAA Privacy Notice - Spanish
- Consent to Treat - Spanish
- Patient Registration Form - Spanish
- Financial Policy
- Notice of Privacy Practices
- Authorization and Consent
- Authorization and Consent to Treatment Form
- HIPAA Authorization to Release PHI
- HIPAA Authorization to Release PHI SP
- Patient Access Records Self/Third Party
- Patient Access Records Self/Third Party SP
- Preferred Contact and Method of Communication
- HIPAA Contact Information
- HIPAA Contact Information Sp
- Medical Record Request English
- Medical Record Request Spanish
- Advance Directive
- Audiogram
OTHER DOCUMENTS
- NOVA KIDS FIRST PARENT HANDOUT 1 MONTH VISIT
- NOVA KIDS FIRST PARENT HANDOUT 10 YEAR VISIT
- NOVA KIDS FIRST PARENT HANDOUT 11 TO 14 YEAR VISITS
- NOVA KIDS FIRST PARENT HANDOUT 12 MONTH VISIT
- NOVA KIDS FIRST PARENT HANDOUT 15 MONTH VISIT
- NOVA KIDS FIRST PARENT HANDOUT 15 TO 17 YEAR VISITS
- NOVA KIDS FIRST PARENT HANDOUT 18 MONTH VISIT
- NOVA KIDS FIRST PARENT HANDOUT 2 MONTH VISIT
- NOVA KIDS FIRST PARENT HANDOUT 2 TO 5 DAY
- NOVA KIDS FIRST PARENT HANDOUT 2 YEAR VISIT
- NOVA KIDS FIRST PARENT HANDOUT 2/1/2 YEAR VISIT
- NOVA KIDS FIRST PARENT HANDOUT 3 YEAR VISIT
- NOVA KIDS FIRST PARENT HANDOUT 4 MONTH VISIT
- NOVA KIDS FIRST PARENT HANDOUT 4 YEAR VISIT
- NOVA KIDS FIRST PARENT HANDOUT 5 YEAR VISIT
- NOVA KIDS FIRST PARENT HANDOUT 6 MONTH VISIT
- NOVA KIDS FIRST PARENT HANDOUT 6 YEAR VISIT
- NOVA KIDS FIRST PARENT HANDOUT 7 YEAR VISIT
- NOVA KIDS FIRST PARENT HANDOUT 8 YEAR VISIT
- NOVA KIDS FIRST PARENT HANDOUT 9 MONTH VISIT
- NOVA KIDS FIRST PATIENT HANDOUT 18 TO 21 YEAR VISIT
NEWBORN & SPECIALTY CARE RESOURCES
- Nest Collaborative handouts (English)
- Nest Collaborative handouts (Spanish)
- New Patient Health History Form (Peds Endocrine)
HEALTH MONITORING FORMS
- Biopsychosocial Assessment
- Bladder Tracker
- Blood Glucose Log
- Blood Pressure Log

CHRONIC CARE & PREVENTIVE HEALTH FORMS
- Diabetic Retinopathy and Early Diagnosis
- Physical Form
- Immunization Form
- My Action Plan
- My COPD Action Plan
- My Diabetes Action Plan
- My Heart Failure Action Plan
- My IHD Action Plan
GENERAL HEALTH & CARE COORDINATION FORMS
- OB/GYN Health History Questionnaire
- Patient Registration Form
- Prapare Screening Questionnaire
- Preventive Medical Visit Patient Info
- Preventive Medical Visit Patient Info (Spanish)
- Psychiatric Collaborative Care - Spanish
- Remote Patient Monitoring Patient Agreement
BEHAVIORAL HEALTH & PARENT RESOURCES
- [P] Advance Directive (Spanish)
- [P] Psychiatric Collaborative Care (Peds): About this Model (Mindoula)
- [S] NOVA KIDS FIRST PARENT HANDOUT 9 AND 10 YEAR VISITS
- [S] Psychiatric Collaborative Care
COORDINATED CARE & CONSENT FORMS
- Vaccination Record
- Virginia School Entrance Form
- Virginia State Sports Physical Form
- Consent DNA Extraction
- ACO Beneficiary FAQ
- ACO Beneficiary FAQ Sp
- ACO Beneficiary Notification
- ACO Beneficiary Notification Sp
INSURANCE ACCEPTED
- Aetna
- Anthem BCBS
- CareFirst BCBS
- Cigna Healthcare
- Humana
- Multiplan/PHCS
- Sentara Health Plans – Commercia
- Sentara Health Plans – Medicaid
- United Healthcare
- Virginia Health Network
- Virginia Premier
- Virginia Medicaid Program
- Virginia FAMIS
Payment Options
We accept cash, Visa, Mastercard, Discover, American Express, and personal checks.
To avoid any delays in billing, we expect payment of insurance co-pays and others at
time of treatment or scheduled appointment.
Card-on-File
We encourage patients to keep a credit card on file to make the checkout process easier,
faster, and more efficient. You will no longer receive statements from us, but you will
continue to receive your Explanation of Benefits (EOB) from your insurance carrier once
your claim has been processed, detailing the charges and payments made on your behalf.
At check-in we will:
- scan the credit card of your choice, including your Flexible Spending Account (FSA)
or Health Savings Account (HSA) card
After your insurance has paid their portion, we will:
- notify you via email of the balance owed
- charge the balance owed to your card on file
- email a receipt for the charge
Your credit card information will always be fully protected by our off-site, card-processing
partner, and not on our computers, as required by industry standards (Payment Card
Industry Data Security Standard – PCI-DSS).
OFFICE FEES
No Shows
Missed Appointment
$50Missed Physical
$100Late Cancellation
$50Missed Pediatric Appointment
$50Missed Procedure
$200Out-Of-Network
New Patients
$200Established Patients
$150Self-Pay
New Patients
$200Established Patients
$150Procedures
$200PAY YOUR BILL
- To pay your bill, please call our billing manager, Ms. Jovita Campanilla at her
direct line: 703-237-6813 or email her at billing.novakidsfirst.com. She will then
call you for more information. Thank you. - Your credit card information will always be fully protected by our off-site, card-
processing partner, and not on our computers, as required by industry standards
(Payment Card Industry Data Security Standard – PCI-DSS). - We accept cash, Visa, Mastercard, Discover, American Express, and personal
checks.

Ready to Schedule Your
Child’s Visit?
We’re here to provide expert, compassionate care for your little one. Book a visit today and take the first step toward your child’s healthy future.