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Contact Us

The Cancer Center at Lake Manassas

7901 Lake Manassas Drive

Gainesville, Virginia 20155

T 703-753-4045
F 703-753-8037
moreinfo@cancercenterlm.org

 

Forms

To save time during registration, save these documents to your computer, print them, and fill them out prior to your visit. (These are .pdf files and you must have Adobe Acrobat Reader installed to read them.)

Referral Source & Medical Team - How did you hear about us? What other doctors are you seeing?

Self-Assessment form (medical history) - Male

Self-assessment form (medical history) - Female

Assignment of Benefits/Financial Responsibility - insurance and payee information

Urinary Symptoms Questionnaire (word document to print and complete prior to prostate consultation.)

 

Preparing for your PET/CT Scan

  • Follow a diet high in protein and low in carbohydrates for a period of 24 hoursprior to your appointment.
  • Do not eat or drink anything for 4 hours before the exam/ test.
  • Medications - except diuretics – may be taken the day of the exam, if they can be tolerated on an empty stomach.
  • Diabetic patients are encouraged to take their oral medications and insulin at least 6 hours prior to the appointment.
  • Strenuous exercise should be avoided for a period of 24 hours prior to your appointment.
  • Please wear warm, comfortable clothing and avoid wearing any jewelry.

Download our PET/CT fact sheet, with information about the exam, what to expect, and how to prepare: PET/CT Fact Sheet for Patients (PDF File)

Preparing for Radiation Therapy Treatments

  • Plan to arrive 10-15 minutes prior to your appointment to complete paperwork.
  • Bring your insurance card and ID.
  • Do not apply skin lotion, sunscreen or other creams before your visit.
  • Visit our Frequently Asked Questions page for more information that might help you prepare for your treatments.