Forms available for download
You may complete the registration forms by opening the appropriate document. The document is in Word format and may then be completed on your computer. Save the completed form for your records and then email the completed form to me at firstname.lastname@example.org.
Please open the Informed Consent for Treatment and print it out for your signature. Review the document and bring the signed document to your first appointment. This document will become a part of your record file in the office.
The Maryland Notice Form is for your records regarding HIPPA regulations as they relate to your rights as a patient. You may save this document in electronic or paper form for your records.
Please download the Pre-Authorization Permission to Charge form in the same fashion and complete as a guarantee of payment. You may return the form via email or bring it with you to the first appointment