ADDRESS

9815 Main Street, Ste 200
Damascus, MD 20872

PHONE

301-747-6543

Patient forms

New Patient forms

Our new patient registration form can be completed online saving you time. Once you complete them, you will be redirected to the main page.

Medical History form is below as a PDF file. You can print, fill and bring them along.

Medical History Form

If a Parent or Legal Guardian is not going to accompany the child, please print below form, sign, date, witness it and send along with caregiver to clinic on day of appointment.

NSKD non parent consent form only

Below are copies of our policies, acknowledgments and consents.

  1. Notice of Privacy Practices NSKD_NOPP_12_20_17
  2. Notice of Non-discrimination NSKD _ Non discrimination notice
  3. Financial & Office Policies NSKD FINANCIAL and Office POLICY only
  4. Billing of Non-covered services NSKD BILLING NON COvered procedures POLICY only
  5. Informed consent for treatment NSKD informed consent policy only
  6. Image Release form NSKD Image Release Form only
  7. In case your child needs conscious sedation. Please complete THIS form. NSKD informed consent for consious sedation
  8.  In case your child needs to go for procedures at hospital, please complete THIS form (coming soon).