New Patients

For your convenience, we have the following new patient forms for your perusal. Please take a few minutes to download, print and complete the following three forms prior to your visit with us. This way, our doctor has more time to spend with you. We appreciate your effort.

If your insurance requires a referral for you to be seen by a specialist, please do not forget to bring your doctor’s referral with you at the time of your appointment. Without it, we cannot bill your insurance for your visit.

For your convenience, we accept major forms of payment, including Visa, MasterCard, and Discover. We look forward to meeting you. We are here to assist you. Please contact our office at (410) 833-2255 should you have further questions.

New Patient Form

Insurance Authorization Form

HIPAA

Privacy Statement

We accept all major insurances. However individual physician’s network participation may vary. In order to receive the highest level of benefits, please check with your health plan to verify physician participation. Please contact our office for verification.

• AARP
• Aetna
• Amerigroup
• American Postal Workers Union (APWU)
• Bankers Life
• Blue Cross/Blue Shield (BCBS)

• Carefirst
• ChampVA
• Cigna
• Coresource
• First Health
• Government Employees Health Association (GEHA)
• Great West
• Health Net
• Humana
• Informed
• John Hopkins
• John Hopkins – US Family Health Plan
• Lifebridge
• Mailhandlers
• MD Individual Practice Association (MDIPA) – Opt Choice
• Medicare
• Medicaid
• Medstar
• Mutual of Omaha
• National Claims Administration Services (NCAS)
• Private Healthcare Systems (PHCS)
• Priority Partners
• Railroad Medicare – DC and Maryland
• Tricare
• United Medical Resources (UMR)
• United Healthcare – Except MCO community Plan
• United Services Automobile Association (USAA)