Thank you for considering our practice for your medical health care. Below are required patient information forms. Appointments cannot be scheduled until registration paperwork is received, reviewed by our physicians, and finally loaded into our computer system. Once your information is in our system, an appointment can then be made. Each family member must fill out registration forms.
Please print out the forms and complete all of the pages. Each page is important for your medical record. When you have completed the forms, please drop them by our office, or fax them to 844-899-3778, or mail them to the office address: 120 Speer Road, Bldg. B, Chestertown, MD 21620.
Unless the physician feels you need more specialized care, your patient account should be established within one week of receipt of your paperwork. Someone from the office will be in contact with you to schedule your initial appointment. The practice participates in most insurance plans; however, you should contact your insurance carrier to verify our participation with your plan before filling our patient registration.
We now offer 2 options for completing the forms below –
- Downloadable PDFs to be printed out and completed by hand. You may return by mail, drop them at the office, or email them back to us at scheduling@
- Online forms that can be completed and submitted online.