When you arrive for your appointment, we will ask you to complete the appropriate forms (see forms below). To make your visit easier, please feel free to download and complete the forms and bring them with you when you come to Family Healthcare of Hagerstown.
Just a note: All mental health patients need to also be Family Practice Patients; therefore, there are likely no additional forms to complete for mental health patients. Simply completing New Patient information for Family Practice will be enough unless you are personally instructed otherwise.
The following forms are for all patients and are also to be completed annually:
Because of the cost of dental services, we ask that all dental patients complete a Financial Assistance form, even if you think that you will not be eligible. The forms are already included in the full dental packet above. Many medical patients, however, can benefit and should apply by completing the form directly below.
The forms must be completed by all dental patients and are already included in the packet above. Many medical patients can benefit as well and should apply by completing the form above.
Hint: if applying, you must also provide supporting documents explained on the form. This form must also be completed annually for anyone wishing to continue benefiting from the Sliding Fee Discount Program.
New! Did you know that if you receive a sliding fee? You can use it in the Family Healthcare Pharmacy also!