GERMANTOWN ORAL & FACIAL SURGERY CENTER


19717 EXECUTIVE PARK CIRCLE
GERMANTOWN, MD 20874

Patient Registration

PATIENT REGISTRATION

Given the ongoing concerns with the Coronavirus, all new patients MUST complete our patient registration forms BEFORE you arrive to the office and email them to us (you will be rescheduled otherwise). If you are unable to do so, please call the office and other arrangements will be made.

Please arrive no more than 10 minutes prior to your scheduled appointment time.

You must wait in your car and call our office to inform us of your arrival.

Please click this link for the full Patient Registration Packet

  1. Patient Registration Form
  2. Health Questionnaire
  3. Privacy Practice Notice
  4. Financial Policy Disclosure & Agreement
  5. COVID-19 Notice
  1. Insurance cards and/or information
  2. Referring dentist’s treatment referral form
  3. Any appropriate x-rays.
These must be sent to our office prior to scheduling your consultation appointment.
© 2022
Rockville, Gaithersburg,Clarksburg, Damascus, Urbana, Federick MD
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