FORMS: (click on image to see forms)

New Patient Intake Form (everyone)

Consent for Treatment (everyone)

Referral Form (doctor referred patient/ insurance required pre-authorization patient)

HIPPA Form (everyone)

 

Acknowledgement Notice of HIPPA Form (everyone)

HIPPA Signature Form (everyone)

Work Compensation patients only:

Work compensation Authorization Form                        (work compensation only)

Work Injury Form                                                             (work compensation only)

New Patient Intake Form 

Consent for Treatment 

HIPPA Form

 

Acknowledgement Notice of HIPPA Form 

D.C. office:   (240)-778-4568

                              

M.D. office:   (301)-838-0524

                     (240)-778-4568

 

Location

DC Office:

1010 Vermont Ave. N.W. #501 Washington, DC. 20005

MD Office:

9075 Shady Grove Ct. 

Gaithersburg, MD 20877

 

DC office:

Mon      11AM-4PM

Tue        11AM -6:00PM

Wed       Closed

Thurs    11AM- 6:30PM

Friday   Closed

Satur     Closed

Sun       Closed

MD office:

Tues     9:00AM - 6:00PM

Wed     By appointment only

Thurs   9:00AM - 6:00PM

Friday  12PM- 5PM

Sat       9:00AM - 5:00PM

Sun      Closed

                   

COVID19 consent Form (everyone)

HIPPA Signature Form

COVID19 consent Form (everyone)

** Work compensation patients must bring a letter of approval. Information such as case manager, adjuster, company, etc maybe required. Letter of approval needs to have practitioner's name, time and date of approval treatment. Please have all your information ready before delaying of treatments.

**Please read carefully as there are new HIPAA guidelines