Patient Forms for your first visit to our facility

Patient Forms

Please download and complete these four patient forms and bring them with you for your first visit.

Thank you.


Patient Health Questionnaire (2 pages)

Payment Policy/Consent to Treat Form

Patient Registration Form

HIPAA Consent Form

Urbana Office

Casabella Commons
3536A Urbana Pike
Frederick, MD 21704
301-874-9202 (fax)

Monday–Thursday: 7 am–7 pm
Friday: 7am–5 pm
Saturday: 9 am–1 pm


New Market Office

FreeZone Fitness
11670 Old National Pike
New Market, MD 21774
301-874-9202 (fax)

Mon. & Wed.: 9 am–7 pm
Friday: 9 am–3 pm
Tues. & Thurs.: By appointment