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
  2. Notice of Non-discrimination
  3. Financial & Office Policies
  4. Billing of Non-covered services 
  5. Informed consent for treatment
  6. Image Release form
  7. In case your child needs conscious sedation. Please complete THIS form. NSKD informed consent for consious sedation