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

Notice of privacy practices for protected health information

HIPAA Notice of Privacy Practices

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

New Patient Packet Form

Get Started on Your Journey to Better Health!

New Patient Packet Form

Authorization for Release of Protected Health Information to NCARD

Authorization for Release of Protected Health Information to NCARD allows the sharing of a patient’s confidential health records with NCARD for the purpose of coordinating care, treatment, or other healthcare-related services, in compliance with privacy regulations.

Release of Protected Health Information to NCARD

Authorization for Release of Protected Health Information by NCARD

The Authorization for Release of Protected Health Information by NCARD enables the secure sharing of a patient’s confidential health records with NCARD. This process facilitates seamless coordination of care, treatment, and other healthcare-related services while adhering strictly to privacy regulations.

Release of Protected Health Information by NCARD

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

Please complete the Acknowledgement Form at Nasseri Clinic to confirm that you have received and understood all the necessary information regarding your treatment and services.

Acknowledgement Form