Below you will find the necessary forms if you are a New Patient. Please print and fill out these forms prior to your appointment. We ask that you arrive 15-20 minutes prior to your scheduled appointment, this way we can complete the check-in process, as well as, add insurance information to get you into your appointment more efficiently. If you have any questions, please do not hesitate to contact us.


Patient History Form

Telehealth Visit Consent Form

Medical Records Release Form

Insurance Information

(Updated 2/1/2023)

Insurance providers we accept
  • Aetna (not Aetna Better Health)
  • Aetna Medicare
  • Anthem BCBS (Not Anthem Healthkeepers)
  • Auto lnsurance
  • Blue Cross (if there is а suitcase on the card with РРО) **OUT OF STATE SHOULD СНЕСК W/ THEIR PLAN**
  • Carefirst (not Carefirst Community Plan, or Carefirst Dual Complete)
  • Carefirst Medicare Advantage PPOs
  • Cigna/Great West (**NOT CIGNA ЕРО – THIS PLAN REQUIRES SPECIAL INVITE FROM CIGNA)
  • GEHA
  • Johns Hopkins Advantage MD
  • Johns Hopkins
  • Maryland Medical Assistance
  • Maryland Physicians Care МСО
  • Medicare Part В
  • Medstar Employee lnsurance Plan (not Medstart Family Choice МСО)
  • Medstar Family Choice (only Dr. Pomilla)
  • Multiplan
  • PHCS
  • Railroad Medicare
  • Tricare for Life (we are out of network providers)
  • Tricare Standard (we are out of network providers)
  • UMR (а United Product)
  • United Health Care (not United Community Plan)
  • United Medicare Advantage (WE ARE CONSIDERED OUT-OF-NETWORK FOR ALL – MORE LEFT ТО РТ) *** THIS INCLUDES ТНЕ UNITED AARP MEDICARE ADVANTAGE РРО PRODUCT ***
  • US Family Health Plan (Тricare through Johns Hopkins)
  • Workers Compensation
Insurance providers we DO NOT accept
  • Aetna Better Health (МСО)
  • Amerigroup (МСО)
  • AARP Medicare Complete Medicare Advantage
  • Carefirst Community Plan (МСО)
  • Carefirst Medicare Advantage HMOs
  • Carefirst Medicare Advantage Dual EligiЫe (BCBS-DSNP)
  • Humana НМО
  • JAI (МСО)
  • Kaiser (Unless they have the option to go through PHCS)
  • Medstar Family Choice (only Dr. Pomilla)
  • Out of State Medicaid or DC Medicaid Products Priority Partners (МСО)
  • Tricare Prime
  • United Community Plan (МСО)
  • University of Maryland Health Partners Wellpoint (МСО)

 

Patient Education

Watch the video below

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