You must have JavaScript enabled to use this form. Evusheld Online Self-Referral Form for COVID-19 Negative Patients NOTICE: Treatment Criteria and Availability Please submit the form below if you are COVID-19 negative and meet the criteria noted. Note that you will ONLY receive a call to schedule a treatment if: 1) patient meets the current eligibility criteria; and 2) we have supply available. Thank you for your understanding.

Recovering from the COVID-19 Virus The Road to Recovery For many people whose bodies have been affected by COVID-19, the road to recovery is just beginning when they leave the hospital or recover at home. The virus can affect many different systems within the body – from the lungs, to the heart, to the muscles that make walking and talking possible. People recovering from COVID-19 may experience a combination of cognitive, psychological, and physical signs and symptoms that remain for weeks to months after the virus leaves the body.

Inova is taking the appropriate steps to protect the safety of our patients, family members and community. In light of the COVID-19 regional situation, the following classes, events and groups have been cancelled. Thank you for your patience and understanding. We look forward to continuing to provide world-class healthcare – every time, every touch – to each person in every community we have the privilege to serve. Women's Services All maternity tours, latch checks, outpatient lactation consultations and mom support groups are canceled until further notice.

If you need financial assistance, also known as charity care, with your hospital bill, speak with an Inova financial quality coordinator at the appropriate phone number listed below.

Health Plans Accepted at Inova* With our five hospitals and locations across Northern Virginia, including urgent and emergency care centers, physician offices and physical therapy centers, Inova offers convenient access and choice to the communities we serve. If you are seeking information about Innovation Health, the result of a unique partnership between Inova and Aetna, more details can be found at www.innovationhealth.com. If you would like to rely on Inova for your health and medical needs and are able, please consider choosing a health plan that gives you access to Inova.

Information on Health Insurance Exchanges The Affordable Care Act (ACA) created guidelines for a new kind of marketplace for health insurance. Health insurance exchanges are available for you to shop for health insurance online. Depending on the type of insurance coverage you wish to purchase and your total household income, you may be eligible for subsidies on the premiums you pay. Inova wants our communities to be aware of health insurance exchanges. For additional information, go to https://www.healthcare.gov.

Our top priority at Inova is to provide every patient with high quality, safe, and affordable healthcare. It is our mission and privilege to serve each individual in the community and to ensure that all patients are well cared for and fully understand the cost of the treatment they receive. Inova is committed to providing meaningful information about our charges and to helping patients and families understand the financial obligations they will have for healthcare services.

Inova VisitPay Inova VisitPay makes paying your healthcare bill simple, clear and convenient. View your bills for your entire household, make a one-time payment, or set up a finance plan. Determine How to Pay Your Bill: I have a billing statement from Inova or I already have an Inova VisitPay account.  Sign up for VisitPay | Login If you have a billing statement for an account in collections with Aargon. Pay a Past Due Bill Balance Billing protection for out-of-network services

Interpreter Services are Available Free of Charge Inova wants to keep you safe and provide you with excellent care. To ensure effective communication, Inova will make interpreters available at no cost to you. Let us know if you need assistance with communication due to hearing, vision and/or speech impairments, or if you want to communicate with your providers in a language other than English. Our healthcare team respects the unique attributes of our patients and families and we promote quality care that is sensitive to all patients' needs.

Make a Request To receive a copy of your medical record, print out and complete our authorization form below and mail or fax it to the hospital or facility where you received service. Appropriate address and fax numbers, along with a contact number for more information, are listed further below on the page.