Forms

New Patient Forms

You may either print out your form and fill it out by hand or type directly onto the form below once you have selected “text”, then print and bring the form with you.  Due to HIPAA regulations, please do not fax any of these forms back to us.

Medical Records Request

If you need a copy of your medical records please download the Medical Record Release Form below and fax or mail it to the office. You will need to personally sign this request.

Please note:  We are not allowed by Maryland law to forward records from other physicians. We will charge for sending copies of your records in compliance with Maryland law. Allow 7-10 business days for processing medical records requests.

Work Leave Forms

Please submit your work leave forms to our Office Manager to be completed. As with medical records, please allow 7-10 days for completion. There is a $20 fee (payable by credit card, cash or check) for these forms to be completed.

Billing questions

Our billing is handled by a centralized facility for all of Capital Women’s Care.

Practice Management Partners: 1-800-529-3489

 

 

Forms

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