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.
New Patient Forms – Family Practice
New Patient Forms – Dental Adults/Children
- Welcome Packet/Registration (English)
- Welcome Packet/Registration (Spanish)
- Healthy Smiles in Motion (Mobile) Patient Packet (New & Yearly)
Current Patient Forms – To Be Completed Annually Or As Needed
- Healthy Smiles in Motion (Mobile) Patient Packet (New & Yearly)
- Registration & UDS Information (English)
- Registration & UDS Information (Spanish)
- Notice of Privacy Practices (English)
- Notice of Privacy Practices (Spanish)
- Release of Information (English)
- Release of Information (Spanish)
- Consent for Child if Parent/Guardian Is Absent (English)
- Consent for Child if Parent/Guardian Is Absent (Spanish)
- Dental Health History – Dental Patients Only (English)
- Dental Health History – Dental Patients Only (Spanish)
- Financial Assistance Form (English)
- Financial Assistance Form (Spanish)