Patient Forms

Appointment Forms

Patient Registration Form

Practice Privacy Policy

Laser Treatment Agreement

Laser Treatment History Form

We see patients on an appointment basis and ask that you call in advance so that we may reserve a time for you. We will see patients with urgent medical needs as soon as possible. Appointments are preferred to eliminate waiting, but walk-ins can be accommodated. If you cannot keep your appointment, please allow 24 hours notice. There will be a $50.00 fee for a missed appointment.

Insurance and Payments

Insurance:
We participate in most insurance plans, including Medicare. If you are not insured with a plan that we do business with, payment in full is expected at each visit. If you are insured, then please read the information below.

Co-Payment and Deductibles:
All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on your part to submit co-payments and deductibles can be considered fraud.

Non-Covered Services:
Please be aware that your doctor may consider a service necessary for your care while your insurance company may not cover its cost.

Proof of Insurance:
All patients must complete or verify the correctness of our patient information form before seeing a doctor. We must obtain a copy of your current valid insurance card.

Claims Submission:
As a courtesy to you, we will submit your claim and assist you in any reasonable way to get your claims paid.

410.997.9751
2000 Century Plaza
10632 Little Patuxent Parkway, Suite 111
Columbia, MD 21044