Forms

Before Your First Visit

Click on the buttons below to view and print our new patient forms that you can complete comfortably and at your own pace at home. Then when you bring them into the office you’ll be all ready to go, saving you time and ensuring you didn’t forget anything important.

Financing and insurance can be simpler than they seem. Call us today at (703) 671-1001.
We’re excited to work with you in achieving your best smile.

Accessibility Statement

We are continuously working to improve the accessibility of content on our website, but please do not hesitate to contact us if you have any questions or require assistance.

If you have trouble seeing web pages, the US Social Security Administration may have resources that will help you. You can also use the Accessibility features of your computer and/or software to:

– Use the keyboard to navigate screens
– Increase text size
– Magnify your screen
– Change background and text colors
– Make your mouse pointer more visible

If you are looking for mouse and keyboard alternatives, speech recognition software such as Dragon Naturally Speaking may help you navigate web pages and online services. This software allows the user to move focus around a web page or application screen through voice controls.

We are committed to ensuring we meet all of your needs. If you require assistance with any of the content on our website, please call our office at (703) 671-1001 and we will do everything in our power to assist you. Thank you!

Privacy Policy

What information do we collect?
When ordering or registering on our site, as appropriate, you may be asked to enter your name, address, e-mail address, or phone number. You may, however, visit our site anonymously.

What do we use your information for?
Any of the information we collect from you may be used in one of the following ways:

To improve customer service (Your information helps us to more effectively respond to your customer service requests and support needs.)
To process transactions (Your information, whether public or private, will not be sold, exchanged, transferred, or given to any other company for any reason whatsoever, without your consent, other than for the express purpose of delivering the purchased product or service requested.)
To administer a contest, promotion, survey or other site feature
How do we protect your information?
We implement a variety of security measures to maintain the safety of your personal information when you place an order or enter, submit, or access your personal information.

Do we use cookies?
We do not use cookies.

Do we disclose any information to outside parties?
We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information. This does not include trusted third parties who assist us in operating our website, conducting our business, or servicing you, so long as those parties agree to keep this information confidential. We may also release your information when we believe release is appropriate to comply with the law, enforce our site policies, or protect our or others rights, property, or safety. However, non-personally identifiable visitor information may be provided to other parties for marketing, advertising, or other uses.

Third Party Links
Occasionally, at our discretion, we may include or offer third party products or services on our website. These third party sites have separate and independent privacy policies. We therefore have no responsibility or liability for the content and activities of these linked sites. Nonetheless, we seek to protect the integrity of our site and welcome any feedback about these sites.

Online Privacy Policy Only
This online privacy policy applies only to information collected through our website and not to information collected offline.

Your Consent
By using our site, you consent to our privacy policy.

Changes to Our Privacy Policy
If we decide to change our privacy policy, we will post those changes on this page.

Contacting Us
If there are any questions regarding this privacy policy you may contact us using the information below.

FairlingtonDental.com
Michael Rogers, DDS
Fairlington Dental
4850 31st Street South, Suite A Arlington, VA 22206
(703) 671-1001
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