New Patient Worksheets

                         Please download to fill out and

return via email, fax or bring with you to your first appointment.

Child & adolescent Paperwork

New Patient WorkSheet- Adults

Office Policies

  • Copayments are due at the time of service. Cash or credit are the only acceptable forms of payment.

 

  • There is a fee for missed appointments as permitted by your insurance company and where not permitted, patients who fail to show to multiple appointments may be discharged from the practice.

 

  • Bring your drivers' license and insurance card with you to every visit.  If you are under 18, a picture or photo identification is still necessary.

 

  • Arrive a few minutes early to complete the necessary paperwork.

 

  • Realize that we do everything we can to validate your insurance coverage and benefits before your visit.  However, it is still your responsibility to know the coverage and benefits of  your insurance.  If a service is not covered by your insurance, you are responsible for and will be billed for the outstanding amount.

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Contact Us!

Phone: (443) 526-6133

Fax: (443) 526-6134

Visit Us!

611 South Union Avenue,

Havre de Grace, MD

21078

112 Red Toad Rd

north East, MD

21901

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