Call Us Today
703-379-6400
Call Us Map Us Email Us Text Us
  • About
    • Meet the Doctors
      • Meet Dr. Zeyad Mady
      • Meet Dr. James Geren
      • Meet Dr. Fatemeh Mojarrad
      • Meet Dr. Pouria S. Rahini-Madjzoub
    • Meet Our Team
    • Meet Our Visiting Specialists
    • Tour Our Office
    • Areas We Serve
      • Alexandria, VA
      • Washington, DC
      • Arlington, VA
    • Our Vision and Values
    • Community Involvement
  • Services
    • Cosmetic Dentistry
      • Cosmetic Dentistry
      • Invisalign Clear Braces
      • Porcelain Veneers
      • Teeth Whitening
    • Dental Implants
    • Dentures
    • Dental Crowns & Bridges
    • Periodontal Treatments
    • Restorative Dentistry
      • Restorative Dentistry
      • Dental Crowns & Bridges
      • Dental Implants
      • Dentures
      • Periodontal Treatments
    • Emergency Dental Care
    • Family Dentistry
    • Pediatric Children Dentistry
    • Invisalign Clear Braces
    • Root Canals
    • Snoring & Sleep Apnea Treatment
    • TMD/TMJ Treatment
    • Tooth Extractions
  • Dental Sedation Options
    • Dental Sedation
    • IV Sedation
    • General Anesthesia
  • Special Needs
    • Special Needs Dentistry
    • Dental Phobia!
    • Medically Complex Cases
    • Autism Spectrum Disorder, ADHD, and Asperger’s Symptom
    • Physical and Mental Disabilities
  • Showcase
    • Smile Gallery
    • Patient Reviews
  • Patient Info
    • Patient Forms
    • Doctor Referral Form
    • Financing and Insurance Options
    • Pay Online
  • Blog
  • Contact
    • Contact Us
    • Request An Appointment

Alexandria, VA Dentist » Patient Forms

Patient Forms

Dental Patient Forms

  • Confidential Info Questionaire
  • Medical History
  • Dental History
  • Medical Clearance

Privacy Policy

  • Dental Photography Release
  • Privacy Notice 1
  • Privacy Notice 2

CDA Authorization

  • Release Records from CDA
  • Release Records to CDA

Financial

  • Financial Arrangements
  • Credit Card Authorization Form

Contact Us

    Our Location

    Center for Dental Anesthesia
    5284 Dawes Ave
    Alexandria, VA 22311
     Call: 703-379-6400
    Center for Dental Anesthesia smile gallery
    Review Us on Facebook
    Leave Us A Review
    facebook YouTube
    Follow Us

    Send a Payment

    Send Us A Message

      Alexandria dentists Dr. Zeyad Mady and Dr. James Geren and their team at Center for Dental Anesthesia provide exceptional dentistry using IV sedation and general anesthesia for people for whom conscious sedation doesn't work or additional considerations are required. These may include anxious or phobic patients, children uncooperative to get treatment, and adults with disabilities or health conditions. They offer a wide range of dental services, including: general dentistry, family dentistry, emergency dental care, teeth whitening, cosmetic dentistry, dental implants, dentures, and specialized care for pediatric patients and patients with special needs. Patients come from all over Northern Virginia and Washington, DC, and especially from Alexandria, Annandale, Arlington, Prince William County, and much of the state of Maryland.
      Call Us Today703-379-6400
      Center for Dental Anesthesia 
      5284 Dawes Ave
Alexandria, VA 22311
      (2nd Location) Mt. Vernon Center for Dentistry 8101 Hinson Farm Rd, Suite 114
      Alexandria, VA 22306       703-360-5881 cosmeticdentistalexandria.com
      • Center for Dental Anesthesia
        • Home
        • Meet Dr. Zeyad Mady
        • Meet Dr. James Geren
        • Meet Dr. Fatemeh Mojarrad
        • Meet Dr. Pouria S. Rahini-Madjzoub
        • Meet Our Team
        • Meet Our Visiting Specialists
        • Smile Gallery
        • Patient Reviews
        • Patient Forms
        • Tour Our Office
        • Blog
        • HIPAA Patient Privacy Practices
        • Privacy Policy
        • Accessibility
        • Contact Us
      • Sedation
        • Dental Sedation Options
        • Dental Phobia!
        • IV Sedation
        • General Anesthesia
      • Special Needs Dentistry
        • Special Needs Dentistry
        • Physical and Mental Disabilities
        • Autism Spectrum Disorder, ADHD, and Asperger’s Symptom
        • Medically Complex Cases
      • Dental Services
        • Cosmetic Dentistry
        • Dental Crowns & Bridges
        • Dental Implants
        • Dentures
        • Emergency Dental Care
        • Family Dentistry
        • Invisalign Clear Braces
        • Periodontal Treatments
        • Porcelain Veneers
        • Restorative Dentistry
        • Root Canals
        • Snoring & Sleep Apnea Treatment
        • Teeth Whitening
        • TMD/TMJ Treatment
        • Tooth Extractions
      Center for Dental Anesthesia © 2025 | Propelled by LUMN | Internet Marketing by ProspectaMarketing

      TEXT OUR OFFICE

      Text message is limited to 160 characters.

      HOW IT WORKS
      1. Enter your Name.
      2. Enter your Cell Phone Number, area code first
      3. Enter your text message in the box.
      4. Click "Send Text"
      5. A copy of this text will be sent to the office and to your cell phone. The office's reply will also be sent to your cell phone where you can continue the text conversation.
      Note: Mobile message and data rates from your cell phone carrier may apply.Close ClickToCall Button
      NagiosCheckValue - Do not remove please