Patient Forms and Documents

To expedite your first appointment, please print and complete registration forms so that we have all the necessary information to treat your child.

New Family Initial History Questionnaire 

Items 1-4 below need to be completed and returned to us.
Items 5-7 below are for your information and do not need to be returned to us.

  1. Consent Checklist for Minor Children (rev 8/2020)- Please complete and print
  2. New Patient Demographic Form (rev 8/2020)- Please print and complete
  3. Patient Portal and CHADIS Form (rev 1/2021)- Please print and complete
  4. Credit Card on File Form (rev 8/2020) - Please complete and print
  5. Policies and Fees - (rev 4/2022)
  6. Financial Policy  - (rev 8/2020)
  7. Notice of Privacy Practices - (rev 8/2020)

Adolescent (11-17y) Patient Portal Form

Request for Release of Medical Records (from another Dr. to us)

HIPAA Privacy Form (Patients 18y or older) - To be completed by the 18+yr old Patient

You may be asked to bring in a completed parent and/or teacher Vanderbilt form for your child's upcoming ADHD appointment. You can find these forms by clicking on the links below.

Contact Us

Please use the phone or fax number below to contact the office:

Phone (301) 774-4100
Fax (301)774-7648

Office Hours
Monday: 08:30 AM - 05:00 PM
Tuesday: 08:30 AM - 05:00 PM
Wednesday: 08:30 AM - 05:00 PM
Thursday: 08:30 AM - 05:00 PM
Friday: 08:30 AM - 05:00 PM
Saturday Sick Hours: 08:30 AM - 11:00 AM
Sunday mornings: By Arrangement
  If you or your child needs to be seen outside our scheduled office
  hours, we recommend using the urgent care center, PM Pediatrics.
  Please remember to always call the answering service
  first to speak to the doctor on-call.