Patient Center


 

Forms


PRIMARY CARE PATIENT INTAKE FORMS

For Primary Care patients, please complete the following intake forms under Primary Care Patient Intake Forms. Once you set your appointment, print out forms, complete them and bring the forms on the day of your appointment.
Also, bring a list of all your current medications with dosages, your recent medical records, labwork and immunization records from past 2 years to your first appointment.

Download

 

WEIGHT LOSS & WELLNESS INTAKE FORMS

For clients enrolling in our Wellness & Weight Loss program, please complete the following forms under Wellness and Weight Loss Intake Forms and bring to your appointment (in addition to the new patient intake forms).
Also bring a list of your current medications with dosages and your most recent labwork with you to your first appointment.

Download

 

INTEGRATIVE / HOLISTIC HEALTH INTAKE FORMS

For clients enrolling in our Integrative / Holistic Health Programs, please complete the following forms and bring to your appointment (in addition to the new patient intake forms)
Also, bring a list of all your current medications with dosages, your recent medical records, labwork and immunization records from past 2 years to your first appointment.

Download

 

Location
Eze Health Center
11750 Business Park Drive, Suite 103
Waldorf, MD 20601
Phone: 240-245-5956
Fax: (888) 519-5179
Office Hours

Get in touch

240-245-5956