Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.
Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Below are links to forms we recommend be a part of your medical records. Please print, complete and bring these forms with you to your next appointment:
- Advanced Directive (District of Columbia)
- Advanced Directive (Maryland)
- Advanced Directive (Virginia)
- Care Visit Form
- Email Release Form
- Five Wishes Living Will
- Medicare Wellness Visit Check List
- New Patient Registration Forms
- New Patient Registration Forms – Español
- New Patient Questionnaire Form
- Patient Policy Form
- Patient Policy Form– Español