Patient Information

Patient Forms

The following forms can be printed out, and the completed forms brought to your appointment:
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Please note that the email addresses on the unsecured areas of our website (unlike those areas that require a sign-on and are password protected) do not provide the same level of security as secured email. For that reason, please be advised that any information you wish to share with us will not be transmitted thru a secured email.

General Information

The office has a 15 minute grace period policy. If you arrive more than 15 minutes after the scheduled time of your appointment, we may require you to reschedule in order to avoid delaying other patients' appointments. Exceptions may be made at our discretion, depending upon the circumstances and time constraints.

Please make sure you always have your actual insurance card (no temporary or print outs will be accepted), picture ID, and a valid referral, (if necessary), at the time of your appointment. Failure to provide these documents will result in your appointment being canceled or you will ask to be self pay for the visit. We apologize for any inconvenience.

You must also inform the office of any change in your information such as insurance, address and telephone numbers, etc. If new insurance information is not given prior to your appointment, your appointment will be canceled until the office obtains the information or you can be self pay at the time of service. We apologize for any inconvenience.

Payment Information

We must collect your required co-pay at every visit. We accept cash (exact change only), check or money order. All return checks are subjected to a return check fee of $40.

Appointments that are not cancel/re-schedule at least 48 business hours prior to any scheduled appointment for regular care are subject to a $40.00 no show fee.

Appointments that are not cancel/re-schedule at least 48 business hours prior to any scheduled appointment for Functional Capacity Examination are subject to a $200.00 no show fee.

Appointments that are not cancel/re-schedule at least 48 business hours prior to any scheduled appointment for Neuro-Psychological Test are subject to a $500.00 no show fee.

Appointments that are not cancel/re-schedule at least 48 business hours prior to any scheduled appointment for Psychological Test are subject to a $200.00 no show fee.

Appointments that are not cancel/re-schedule at least 48 business hours prior to any scheduled appointment for Psychotherapy are subject to a $50.00 no show fee. Also, if I missed two (2) consecutive appointments, I will not be allowed to pre-schedule future appointments.

Appointments that are not cancel/re-schedule at least 48 business hours prior to any scheduled appointment for Group Therapy are subject to a $50.00 no show fee.

Appointments that are not cancel/re-schedule at least 48 business hours prior to any scheduled appointment for NeuroDiagnostic Testing are subject to a $200.00 no show fee.

All payment for services rendered are due at time of service; if they are not paid, a $10.00 billing fee will be assessed to your account.

If payments are not received within thirty (30) days of the original billing, a $10.00 re-billing fee will be assessed.

Any checks returned will have a $40.00 fee assessed.

A late fee of $15.00 will be assessed every 90 days after the initial billing date and will be assessed an 18% APR fee every 90 days after the initial billing date.

These amounts must be paid in full prior to any further service provided by our office.

Your First Visit

On the first visit you will be required to complete the following forms (Patient registration, Patient Questionnaire and E-prescription consent form). If you have any health records from previous physicians, please bring them with you. You may print and fill out the forms in advance to save time. Please also bring a list of any medications you are currently taking. We suggest that all new patients plan to arrive 15 minutes before their appointment time to allow for processing.

Existing Patients

All existing patients are required to fill out the Patient Questionnaire; you may print out the form prior to your appointment to expedite your visit. Please also bring a list of any medications you are currently taking.

All patients are required to fill out a new patient registration form at the beginning of the year, every 6 months and whenever any of your information changes. All the forms can be printed out and completed prior to the visit for faster service.

Insurance Information

We do not accept all insurances, so please call your insurance company to verify if the physician you would like to see is in network. Since we have several physicians that have their own private practice, when calling your insurance company, verify that the physician is participating under Washington Medical Group, P.C.

Patients are responsible for knowing their insurance benefits.

Referral Information

There is a 72 hour processing time for referral requests. Please fill out the form on the website completely or if calling, have the physicians name, address, phone number, fax number, reason for the referral, and your insurance information available. Any incomplete information may cause a delay on your request. No backdated referrals will be given.

Prescription Information

There is a 48 hours processing time for prescription requests. Please be advised that some of our physicians are not in the office full time, so please allow sufficient time to process your request. Call ahead of time before running out of your prescription. Any incomplete information may cause a delay on your request.

Frequently Asked Questions (FAQ)

How can I get diagnostic results (laboratory, radiology etc)?

Obtaining test results require a face-to-face consultation with a licensed medical professional. Test results cannot be given over the phone, email and/or via facsimile. These regulations are in compliance with appropriate medical care guidelines and other government agencies within the District of Columbia.

How can I find out what my co-payment is?

There are three ways you can find out the cost of your co-payment. You can call your insurance, look at your benefits via online or talk to your Human Resources administrator.

Can I be billed for my co-payment?

We are required by insurers to collect your co-payments at the time of service. However, in an event that you are unable to make a payment at the time of your visit, you will be billed for the amount of your co-payment and an additional $10.00 fee.

How can I get a copy of my medical record?

If you desire your own copy, you must provide the office a written request for your medical records or fill out the patient medical records request form. Any incomplete information may cause a delay in your request. Your request may take up to thirty days to complete. Your request will incur the following fees: our office charges a reasonable, cost based fee for providing patients with copies of their records. The fees will only include the cost of supplies for and the labor of copying, postage if the individual has requested that the information be mailed, and cost for preparing an explanation or summary of the information if agreed to by the individual. See 45 CFR 164.524.

How can I request for my medical record to be forwarded to another physician?

We will make a single copy to send to another physician's office at no charge to you. You must provide the office a written request or fill out the medical records request form. Please include the physician's name, address, telephone number and fax number. Any incomplete information may cause a delay on your request

What do I need to do if I am scheduled for surgery?

Find out first if you need a preoperative physical exam. Your surgeon's office can tell you this. If so, call to schedule it as soon as you know the date of your surgery. Allow sufficient time for all your test results to be performed and for the results to come back. This may take up to 2 weeks or more.