National Integrated Health Associates

5225 Wisconsin Ave. NW Suite 402, Washington, DC 20015 • 202-237-7000
    Patient Forms

    Patient Information

    Thank you for making your appointment at NIHA.
    We welcome you and look forward to helping you achieve a higher level of health through integrative medicine.

    Prior to your first appointment In order to expedite your first appointment please download  forms  and complete registration and medical/dental history prior to your arrival.  It may take up to one hour to complete these forms, and we  want you to get the maximum benefit  from your time here.

    If forms are not completed before your appointment, please arrive at least one (1) hour prior to your scheduled appointment. These must be thoroughly completed in order to do a comprehensive evaluation.    Dr. Rind's New Patients: Forms must be received  3 days in advance of your appointment or we will need to postpone your appointment to allow time for a thorough review of your history.

    PATIENT FORMS TO DOWNLOAD:


    MEDICAL PATIENTS:   Patient Medical Forms

    Medicare Eligible Patients: Use Patient Forms above and additional Medicare Opt Out Form

    Dr. Rind's Patients:

    1) Medical Forms 2) Additional Narrative History Form and Guidelines for Patients  and 3) Review of Systems.
    Optional Information How Low Metabolism Affects Our Health

    Thermography Patients:

    1) Medical Forms  and 2) Breast Health Questionnaire and Pre-Appointment Instructions

    DENTAL PATIENTS:    Patient Dental forms

    Click Adobe Acrobat to download the free application if you are unable to read these files.

    COMPLETED PATIENT FORMS MUST BE FAXED TO 202-237-0017 THREE (3) DAYS BEFORE YOUR APPOINTMENT. Thank you!
     

    Your First Appointment
    Please bring your completed forms and any recent laboratory tests, medical reports, and bottles or samples of all prescriptions, medications, herbs, homeopathics, nutritional supplements, vitamins, etc. that you are presently taking. This is extremely helpful for your initial evaluation. We encourage you to prepare any written questions ahead of time and bring them to your initial appointment.

    Fragrance Free Office
    In order to accommodate our chemically sensitive or allergic patients we kindly ask that you not wear perfume, cologne or scented lotions on your appointment days.

    Payment
    Payment in full is due at the time of service. We accept  cash, check, MasterCard, Visa, Discover and money orders.

     

    Insurance

    We offer our patients comprehensive health care which limits the ability to work within the limitations of most contractual agreements for health insurance. Payment is required at the time of service. NIHA does not accept assignment or file or coordinate insurance reimbursements although we do provide information on the services rendered for you to submit.

    You are responsible for filing your own claim and following up as needed. Please be advised, however, that many of the services provided are not covered by most insurance companies. Please contact your insurance company directly for information on your coverage. We are not providers for HMO insurance, Medicare, or Medicaid. The specific information below should assist you with filing for insurance reimbursement.
     

    DENTAL INSURANCE

    Our goal in the Biological Dental Group is to maximize your benefits and minimize out of pocket expenses. You will receive a dental claim form that will include all necessary information that is needed for you to file for reimbursement, along with a receipt for the services rendered. Payment is due at the time of service.

    Dr. Michelle Janbakhsh is an in-network provider for Delta Dental, Metlife, and Guardian.

    We are out-of-network dental providers for these dental carriers:

    • Aetna
    • Care First Blue Cross Blue Shield
    • Cigna
    • Fortis
    • Humana
    • Mutual of Omaha
    • Principal and others

    We also have flexible payment options with flexible payment options for dental

     

    MEDICAL INSURANCE

    Our goal is to provide you with the highest quality medical care and necessary information for maximizing your insurance benefits and minimizing your out-of-pocket expenses. You will receive a medical claim form that will include all information for you to file for insurance reimbursement, along with a receipt for services rendered. NIHA is an out-of-network provider only and does not participate with insurance companies or other provider networks.

    Payment is due at the time of service unless other arrangements have been made in advance. We generally do not accept assignment of insurance payments.

    CLAIM SUBMISSION
    Insurance claim forms and information is provided to patients at the time of visit for submission to your insurance company. While submission of claim forms is the patient's responsibility, you will receive at the time of check-out everything that you need to immediately file your claim. 

    NOT RECOGNIZED CARE
    NIHA reserves the right in preparing claim submissions to include those procedural codes or other data that accurately reflect services, and to invoice non-covered services using internal descriptions without the use of procedural codes. Please understand that your insurance company may deny coverage because of differences between integrative and conventional medicine. Please contact your insurance company directly for information on your coverage. NIHA will make every effort to provide sufficient information to allow an insurer to determine what services it will reimburse, but it is not responsible for any insurance company decision.

    PRIMARY CARE
    Tracy Freeman, MD may provide limited primary care services as defined by mutual written agreement. For Primary Care services we will verify eligibility and only collect from you that portion that you are responsible for. The patient is responsible for any portion not covered by insurance. Insurance verification is not a guarantee of payment.

    Per Blue Cross Blue Shield policy as of January 2011, Care First Blue Cross Blue Shield  patients are responsible for 100% of their primary care office visit. 

    MEDICARE
    Medicare will not cover any services or procedures performed at NIHA, as the doctors have opted out entirely of the Medicare program. Claims cannot be submitted to Medicare and patients is financially responsible for any services or procedures received. However, Medicare patients will receive a 20% discount and if a patient has secondary insurance we will provide an opt-out letter to assist in getting coverage.

    TRICARE
    Drs. Gant, Rind and Solomon will not accept any new patients or treat patients with Tricare insurance. All other practitioners do accept Tricare insurance for covered services. Patients are responsible for payment in full for non-covered services.

    INSURANCE BILLING SERVICES
    There are individuals and companies which, for a fee, can assist you with claims filing and reimbursement from insurance or flexible spending account administrators. A list of firms offering these services is available upon request.
     

     

    Directions

    From Baltimore & Maryland
    EASIEST: Take I-95 South to I-495 West heading toward Rockville.
    From I-495 take Exit 34 and stay in the far right lane which forks and loops south onto Wisconsin Ave., Route 355 South. ( Rt. 355 South is Rockville Pike, which turns into Wisconsin Ave.)
    Stay on Wisconsin Ave. for about 4 –5 miles, crossing Western Ave. The next light is Jenifer Street. Take a Left on to Jenifer Street. Turn Right down the first ramp into parking garage (same garage as Red Door Spa) The elevators for the building are between the parking garage floors, accessible only via steps. The office is on the 4th floor, suite 402

    FASTEST: Take I-95 South to I- 495 West heading toward Rockville.
    Stay on I- 495 until Connecticut Ave. (Exit 33) Take Connecticut Ave. South toward Washington, D.C. Go ½ way around Chevy Chase Circle and continue straight on Connecticut Ave.
    Turn Right onto Military Rd. and continue for approximately ½ mile
    Turn Left onto 43rd St., go to the end of the block where you are forced to turn Right onto Jenifer St. Take a Left down the last ramp (before Wisconsin  Ave intersection)  into the parking garage (same garage as Red Door Spa) The elevators for the building are between the parking garage floors, accessible only via steps. The office is on the 4th floor, suite 402

    From Virginia
    From I –95 North take the Capital Beltway ( I- 495 North) toward Tysons Corner and Maryland Take I –495 North into Maryland, take River Road East (exit 39) toward Bethesda, MD, and DC Follow River Road for approximately 4 miles Turn Left at Western Ave. and follow for approximately ¼ mile Turn Right onto Jenifer Street Follow Jenifer Street across Wisconsin Ave Turn Right down the first ramp into parking garage (same garage as Red Door Spa) The elevators for the building are between the parking garage floors, accessible only via steps. The office is on the 4th floor, suite 402

    Via Metro
    Take the Red Line to Friendship Heights Metro Station. Exit the station via the Jenifer Street Exit – via elevator. Upon leaving Metro station, 5225 Wisconsin Ave is directly across the street. The office is on the 4th floor, suite 402

    Handicap Access
    The parking garage has handicap parking spaces near the elevators, but to get to the elevators you must walk up or down 7 steps. If steps are difficult to use, we recommend that you park on Wisconsin Ave. in front of the building or on 43rd Street behind the building and use those handicap accessible entrances to the building. If you need assistance, please advise us in advance and we will provide support and a wheel chair if needed. We apologize for the inconvenience.

     


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    Nearby Hotels

    Chevy Chase Motel -0.46 miles away
    5520 Wisconsin Ave, Chevy Chase, MD
    301-656-1500

    Embassy Suites Chevy Chase Pavilion - 0.20 miles away
    4300 Military Road, NW, Washington, DC
    202-362-9300

    Holiday Inn Chevy Chase  - 0.47 miles away
    5520 Wisconsin Ave, Bethesda, MD
    301-656-1500

    Days Inn - 1.30 miles away
    4400 Connecticut Ave NW, Washington, DC
    202-244-5600

    Residence Inn by Marriott- 1.79 miles away
    7335 Wisconsin Ave, Bethesda, MD
    301-718-0200

    Hyatt Regency - 1.84 miles away
    7400 Wisconsin Ave, Bethesda, MD
    301-657-1234

    Bethesda Court Hotel - 2.10 miles away
    7740 Wisconsin Ave, Bethesda, MD
    301-656-2100
     


     
     

    Visit NIHA Wellness Store

    Where We Are Located


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    Center Hours

    Monday - Friday

    8:00 - 6:00

    Saturday 8:00- 12 noon

    Open first and third Saturdays each month

     

     


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