About Medical Access Online

	Medical Access \| 19504 Amaranth Drive, Germantown, MD 20874 \| Phone: 301.428.1070

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	From Prevention to Cure We are here to help meet your health care need…. Whether it’s an immediate, non-life threatening illness or injury, a specific type of physical or to provide overall care and coordination of your health care needs… .. We’re here for you!

Forms

Occupational Forms

Patient Forms

Forms used at Medical Access

Occupational Health Forms

Here are the forms that we use at Medical Access. The Authorization and Request for Services form should be sent with the employee or faxed to us prior to the visit. You may also elect to print and have your employee fill out the other forms before coming to Medical Access. Call our front desk at 301-428-1070 to see what forms will be required.

Patient Forms

Following are the forms that we use at Medical Access:

Patient Registration Form
Immigration Form
Motor Vehicle Accident Form
Annual Physical Form
Medical Records Release Form A (When you want a copy of your records for yourself or you want them sent to another physician)
Medical Records Release Form B (When you want us to get a copy of your records from another physician or facility)