Patient Center · Washington, DC
Registration forms.
If you have any questions, give us a call.
Fillable PDF forms
Download the form, fill it in on your computer or phone, save it, and email it to info@dcperio.com or bring it to your visit.
- Health History Form (PDF)
Your medical history, medications, and insurance, with a Medication List page.
- Authorization for Release of Information (PDF)
Choose who may receive your health information, how we may contact you (voice mail, email, text), and whether we may use your photos.
- Financial Consent (PDF)
Payment and insurance responsibility, and our returned-check, collection, and broken-appointment fees.
- Medical Clearance Form (PDF)
Our request for a medical evaluation from your physician. Page 2 holds your release and the physician's report.
HIPAA notice of privacy practices
Your privacy is important to us. Our HIPAA notice explains our responsibilities with your health information, and you will be asked to sign an acknowledgment in the office. You can read the Notice of Privacy Practices (PDF) before your visit. For a paper copy, call (202) 659-3500 or email info@dcperio.com. See also our website privacy policy.
Questions? The front desk answers them all day.
Two Washington, DC locations, one phone number.