top of page
D.C. office: (240)-778-4568
M.D. office: (301)-838-0524
(240)-778-4568
DC Location:
1010 Vermont Ave. N.W. #501 Washington, DC. 20005
MD Location:
9075 Shady Grove Ct.
Gaithersburg, MD 20877
DC Hours:
Mon 11 am - 4 pm
Tue 11 am - 6 pm
Wed Closed
Thurs 11 am - 6:30 pm
Fri Closed
:MD Hours
Mon 12pm - 6 pm
Tues 9 am - 6 pm
Wed 12 pm - 6 pm
Thurs 9 am - 6 pm
Fri 12 pm- 5 pm
Sat 9 am - 5 pm
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 (everyone)
COVID19 consent Form (everyone)
Work Compensation patients only:
COVID19 consent Form (everyone)
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
HIPPA Signature Form
** 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
bottom of page