New Patients:

Intake Form (Health History)

Registration Form (Health Insurance Information) 

Acknowledgement of Privacy Practices outlined here: 

Privacy Practices Page (download) / Privacy Practices (web-page)

Financial Policy 

Among other things it enables us to email/text message you re: appointments

Established Patients:

Keep our office informed of changes to insurance or address.
Use the billing address to update this.

Prescription Refills:
Can now be requested any time by email.
Click here for instructions.

Billing Questions: 
billing@goodsamaritanmd.com