If you are a new patient to our practice and have an appointment scheduled, you may print out the registration form below, complete and fax it back to us. The office fax numbers are listed under each office location above.
Should you have any questions, or would like to schedule a new patient appointment with us, please call us at 301-662-2775.
- Patient Registration Form
- Patient Medical History Form
- HIPAA Patient Privacy Consent Form
- Directions to Greater Potomac Retina
It is very important that we receive all of the information requested so we can provide the highest level of care for you. In addition, this will allow us to properly communicate with your referring doctor and primary care doctor. Please keep us updated on your insurance information as well so that our billing department can successfully complete all the insurance billing and precertification procedures in a timely fashion.
Thank you for your cooperation in filling out these forms.
About your office visit:
- Your eyes will be dilated for the examination.
- You will need someone to drive you.
- Your visit may last between 1 and 3 hours depending on the type of evaluation.
- Diabetic patients are asked to bring a snack in case the appointment runs into their lunch or dinner time.
Please bring the following with you on the day of your appointment:
- The completed registration forms
- A list of all medications and eye drops that you are currently taking
- Any contact lenses or glasses that you currently wear
- Your current insurance cards
- Co-pays for specialists as noted on your insurance card
- Referrals from your primary care physician if your insurance requires a referral to see a specialist. (NOTE: Without a proper referral, payment will be due at the time of the office visit.)
- A valid picture identification card
NOTE: If Medicare is your only insurance, a co-payment will be collected at the time of the office visit. If we do not participate with your insurance, payment will be collected at the time of the office visit.