New Patient Forms:
Our New Patients should print the following three forms and fill them in prior to your first visit:
1) New Patient Consent to Services : This form contains all of our office policies regarding treatment, payment for services, cancellations, and possible adverse effects. Please carefully read over this form. Treatment cannot begin until this form is signed by you and witnessed by our front desk staff.
Please review our HIPAA Privacy Statement prior to your first appointment: KMA HIPAA Notice for Patients. Our Consent to Services form indicates that you have read and agree to our HIPAA Privacy policies. You may request that we print the HIPAA Privacy Statement for you. Please notify us prior to your arrival if you would like us to print this notice for your records.
2) New Patient Intake Form : Our comprehensive Intake Form is designed to allow us to craft a detailed treatment plan specific to your needs. For your benefit, please complete this form entirely.
3) COVID Pandemic Consent to Services : All patients will be required to sign the COVID-19 Pandemic Acknowledgement and Informed Consent upon starting or resuming treatment. Please print and initial this form.
COVID-19 Pandemic Policies:
KMA safely and successfully resumed treatment offerings on June 1, 2020 during Maryland’s Phase One reopening stage for elective medical procedures. We stay up to date on the latest data and science during this pandemic and have implemented the following policies to keep our doors open to you while maintaining a safe treatment space. Please review our policies before coming to our clinic.
Scheduling an appointment with us indicates you understand and agree to our current COVID-19 Policies and Procedures.
Financial Forms:
Maryland law allows us to provide pre-payment discount packages for out of pocket medical services such as acupuncture and massage. If you wish to take advantage of our pre-payment services, please print, read, and sign the following form prior to your arrival. You will need to initial each paragraph to indicate that you understand the conditions of the package.
