New Obstetrical Patient Information Form

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J
A. G
, MD
UDITH
URDIAN
M
S
, MD
ICHELLE
PECTOR
P
E. S
, PA-C
ATRICIA
HEVOCK
M
T
-H
, CNM
ELANIE
HORNTON
UYCKE
W
P
ELCOME TO OUR
RACTICE
Thank you for selecting our practice for your medical care. We appreciate your trust in us and look
forward to working with you to provide you with the best healthcare outcomes. Our practice consists
of all-female providers whose mission is to provide each of our patients with highly-skilled,
comprehensive, and compassionate care. The health and wellness of our patients is our top concern!
Along
with this letter,
you will
find the New
Obstetrical
Patient
Information
and
Insurance/Precertification Forms that need to be completed prior to your first OB visit. Please bring
these completed forms, your insurance card, and your driver’s license to your appointment.
We ask that you arrive 15-minutes prior to your appointment time so we can process your
paperwork. If you are 10 minutes late for your appointment, you may be asked to reschedule your
appointment in order to allow us to provide timely service for our subsequent patients. We value
your time, however, patient medical emergencies may occasionally occur and cause our providers
to run behind schedule. If this should happen, we ask for your patience and understanding. Our
providers promise to provide the same time, care, and attention to each of their patients.
Please be advised that we require 24-hours’ notice if you are unable to keep your scheduled
appointment. Missed appointments or ones not cancelled with adequate notification will be subject
to a $50 fee.
Appointments are available Mondays through Thursdays from 8 AM to 5 PM and Fridays from 8 AM
to 3 PM. However, same-day appointments are available for emergencies. Our staff will be more
than happy to help you with prescription refill requests and general questions. If your call requires
the attention of one of our medical staff members, our advice nurse will be happy to assist you. Our
providers typically return calls when they are finished seeing patients, unless there is an emergency.
Co-payment is due at the time of service, unless other arrangements have been made prior to your
appointment. We accept cash, check, Visa, MasterCard, and American Express.
We look forward to meeting you. If you have any questions, please do not hesitate to contact us at
301.762.5501.
Healthcare for w om en, by w om en…
9711 Medical Center Drive, Suite 109, Rockville, MD 20850
|
301.762.5501
|
Fax 301.309.8727
1

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