New Patient Forms

Contact Us!

We encourage you to contact your Burke Dentist, Dr. Alireza Palizi, with any questions or comments you may have. Please call our Burke Family & Cosmetic Dentistry or use the quick contact form below.

Office location:
Burke
5216 Lyngate Court
Suite A
Burke, VA
22015
Phone: 703-978-7900

The first visit to our office is designed to get you better acquainted with all we offer as well as introduce you to Dr. Palizi and our caring staff. We encourage questions and do our best to always deliver quality care.

Please take a moment prior to your scheduled appointment to download our patient forms. We ask that you complete the forms and bring them with you to your appointment so we may better assist you in a timely manner. Thank you for your confidence in our office, we look forward to assisting you with all your dental needs.

Patient Forms


This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.