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Patient Forms


 

Please reference and complete the following forms before coming in for your appointment. If any patient information has changed since your last visit, for example your insurance carrier or your address, please let the office know.

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Authorization and Consent to Treatment

 

Preferred Contacts

 

Notice of Privacy Practice

  

Financial Policy

  

COVID Testing Refund Policy

Location
LJ Medical Health and Wellness Clinic
6244 Montrose Road
Rockville, MD 20852
Phone: 878-778-7837
Fax: 301-338-6463
Office Hours

Get in touch

878-778-7837