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
Initial Form.pdf
Adobe Acrobat document [711.5 KB]
Notice of Privacy
NoticePrivacy.pdf
Adobe Acrobat document [1.4 MB]
Assignment of Benefits
AssignmentBenefits.pdf
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.

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)

 

 

 

Email:

info@KidneySpecialists.info

 

 

Office Hours

 

Martinsburg:

Mondays - Thursdays: 9am to 1pm

 

 

Winchester:

Modays: 11am - 3pm

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

 

Leesburg:

Thursdays: 8am - 5pm

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

 

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