Kidney Specialists PLLC
Kidney Specialists PLLC

Patient Forms

Want to save time during your visit with us? Please print and fill out the following forms and bring with you on your first appointment.


Please note that all of these forms have to be filled and brought in to the office at the time of the initial visit.

New patient registeration form
Adobe Acrobat document [379.7 KB]
Notice of Privacy (for your records)
Notice of Privacy.pdf
Adobe Acrobat document [218.6 KB]
Notice of Privacy Receipt (for our practice)
Adobe Acrobat document [167.9 KB]
Assignment of Benefits
Adobe Acrobat document [258.6 KB]

Please don't forget to bring a form of ID and your insurance information with you


In order to register and treat you promptly, we request that our patients bring their current insurance information with them for each visit.


We also accept uninsured and self-pay patients. We are able to set up a payment plan if the charges exceed your budget.

We accept most types of health insurance. Please contact us for further details.

Office Privacy Notice

Notice of Privacy.pdf
Adobe Acrobat document [218.6 KB]

Office Locations:


1004 Sushruta Drive

Suite A

Martinsburg, WV 25401

Phone (304) 449-3778



480 W. Jubal Early Drive

Suite 200

Winchester, VA 22601

Phone (540) 313-6563



821 S. King Street

Suite L

Leesburg, VA 20175

Phone (703) 722-1500





Fax (304) 449-3777

(for all of our locations and for all correspondence and referrals)







Office Hours



Mondays - Thursdays: 8:30am to 1pm




Modays: 11am - 3pm

Tuesdays - Thursday: 8:30am to 12:30pm



Thursdays: 8am - 5pm

Appointments on the other days of the week or late evenings are available


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© Kidney Specialists PLLC