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    Forms

    ENGLISH

    1. PATIENT REGISTRATION

    2. CONSENT TO TREAT

    3. ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY OF PRACTICES

    4. AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS

    ESPAÑOL

    1. REGISTRO DEL PACIENTE

    2. CONSENTIMIENTO PARA TRATAMIENTO

    3. RECONOCIMIENTO DE RECIBO DEL AVISO DE PRIVACIDAD DE PRÁCTICAS

    4. AUTORIZACIÓN PARA LA DIVULGACION  DE REGISTROS MÉDICOS

    LOCATIONS

    COLUMBIA, MD

    9710 Patuxent Woods Dr., Suite 200
    Columbia, MD 21046

    Open Monday to Saturday
    10 AM to 10 PM

    CAMP SPRINGS, MD 

    OXON HILL, MD 

    4821 Allentown Road

    Camp Springs, MD 20748

    DUE TO COVID-19 WE ARE OFFERING
    ON-LINE APPOINTMENTS ONLY

    5474 St. Barnabas Road

    Oxon Hill, MD 20745

    Open Monday to Saturday
    9 AM to 9 PM

    SUNDAYS TELEMEDICINE ONLY

    FOR ANY LOCATION CALL US TO MAKE AN APPOINTMENT AT 443-899-9525

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    fax: 833-605-7347

    info@premierhealthexpress.com

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    Website by ITS International

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