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Patient Form

Patient Form at Nasseri Clinic of Arthritic & Rheumatic Diseases in Maryland

We provide the new patient form online for your convenience and to save you time in your consultation. When you come in for your initial appointment, you can bring this form with you.

Valued Patient: Please complete the “New Patient Forms Packet” and bring it with you as you arrive 15 minutes prior to your appointment so that we can expedite your registration process.

Valued Referring Physician and Staff: Please take a minute to download our “Request for New Patient Appointment” form and send us the completed document via fax at (410) 744-8036.

HIPAA Packet at Nasseri Clinic of Arthritic & Rheumatic Diseases in Maryland

HIPAA Packet

Notice of privacy practices for protected health information

HIPAA Notice of Privacy Practices
Patient Medical History Form at Nasseri Clinic of Arthritic & Rheumatic Diseases in Maryland

Patient Medical History Form

Valued Patient: Along with the completed patient packet, please bring your Photo ID, Insurance Card, and any Copay / Deductible, if applicable. 

Patient Medical History Form
Authorization for Release of Protected Health Information to NCARD at Nasseri Clinic of Arthritic & Rheumatic Diseases in Maryland

Authorization for Release of Protected Health Information to NCARD

Release of Protected Health Information to NCARD
Authorization for Release of Protected Health Information by NCARD at Nasseri Clinic of Arthritic & Rheumatic Diseases in Maryland

Authorization for Release of Protected Health Information by NCARD

Release of Protected Health Information by NCARD
Advanced Directive Form at Nasseri Clinic of Arthritic & Rheumatic Diseases in Maryland

Advanced Directive Form

By completing the Advanced Directive Form at Nasseri Clinic, you take control of your healthcare decisions, ensuring that your wishes are followed if you’re ever in a situation where you cannot communicate them yourself.

Fill Advanced Directive Form
Acknowledgement Form at Nasseri Clinic of Arthritic & Rheumatic Diseases in Maryland

Acknowledgement Form

Acknowledgement Form

HIPAA Packet
Notice of privacy practices for protected health information

HIPAA Notice of Privacy Practices

New Patient Forms Packet
Valued Patient: Along with the completed patient packet, please bring your Photo ID, Insurance Card, and any Copay / Deductible, if applicable. 

Patient Medical History Form

Authorization for Release of Protected Health Information to NCARD

Release of Protected Health Information to NCARD

Authorization for Release of Protected Health Information by NCARD

Release of Protected Health Information by NCARD

Advanced Directive Form

Advanced Directive Form

Acknowledgement Form

Acknowledgement Form

Locations of Nasseri Clinic of Arthritic and Rheumatic Diseases

Catonsville, MD

  • 700 Geipe Rd, Suite 200B, Catonsville, MD 21228
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Glen Burnie, MD

  • 203 Hospital Dr, Suite 300B, Glen Burnie, MD 21061
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Columbia, MD

  • 5500 Knoll North Dr, Suite 250B, Columbia, MD 21045
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North Baltimore, MD

  • 3333 N. Calvert St, Suite 540B, Baltimore, MD 21218
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Rosedale, MD

  • 9114 Philadelphia Rd., Suite 208B, Rosedale, MD 21237
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Edgewater, MD

  • 3168 Braverton St., Suite 330B, Edgewater, MD 21037
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