Health and wellness contract

If you are ready to join our health and wellness program please complete the above form and return to the office.

New Patient

This form is for new patients who are either coming in for the first time or if coming in for care at our new office and were previously treated at Maryland Primary Care. Please print off this form and fill out as much as possible.  If you have any questions, please contact us.

Forms can either be faxed to your current provider, or to us at 443-214-5168 . You can also drop them off at the front desk of our office.

Hippa form

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. This form also offers authorization for third parties ( i.e. spouse, child etc. ) to be able to access your health information.

Transferring care 

If you saw would like to transfer your care to Annapolis Family Medicine, then this is the page for you.  Please print off and complete the information and send to your current primary care provider.  Fill out as much as possible.  If you have any questions, please contact us.

Forms can either be faxed to your current provider, or to us at 443-214-5168 . You can also drop them off at the front desk of our office.