How to Join
If you'd like to learn more about our practice, we would be happy to meet with you. Just contact us and let us know when you would like to come in. If you are interested in joining our practice, you can call or write us and we will send you an enrollment package. These are the forms you will need to fill out and return to us:
Required for Everyone:
Enrollment Agreement - Agreement that describes our relationship.
Patient Information Sheet - Information about you. Please complete one per patient.
Payment Information Sheet - Tell us your preferred method of payment.
Medical Records Release Form - Allows us to obtain your medical records.
Patient Information Sheet - Information about you. Please complete one per patient.
Payment Information Sheet - Tell us your preferred method of payment.
Medical Records Release Form - Allows us to obtain your medical records.
Required if You Are Eligible for Medicare Part B:
Medicare Opt-Out - Agreement that acknowledges that services provided by Mid-Maryland Internal Medicine will not be covered by Medicare.